Role of circadian rhythms in heart failure: insights from myocardial energy metabolism

Heart failure, which is often the final stage of various cardiovascular diseases, remains a major cause of mortality, challenging the efficacy of current therapeutic advancements. Contemporary pharmacological treatments for heart failure aim to mitigate neurohormonal activation, alleviate volume overload, and provide inotropic support, particularly under conditions of hemodynamic instability. Despite these efforts and advancements in medications and medical technology, the mortality rates associated with heart failure continue to be alarmingly high. Recent research has increasingly focused on disruptions in cardiac energy metabolism and their contributions to the development of heart failure. These metabolic disturbances are closely associated with the circadian clock, which is a critical regulator of cardiac energy balance and essential for maintaining heart function. In this review, we summarize how the circadian clock influences cardiac energy homeostasis and how its disruption can lead to detrimental changes in various metabolic pathways in the heart, potentially precipitating heart failure. Furthermore, we propose preventive and therapeutic strategies that focus on correcting the imbalances in myocardial energy metabolism regulated by circadian rhythms. These strategies may present promising avenues for improving the treatment and management of heart failure.