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This process supports

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These cells remain metabolically active, adopt a distinct phenotype (including chromatin changes), and critically secrete a variety of pro-inflammatory cytokines, proteases, growth-factors and extracellular-matrix modifying signals

There is a shifting trend in the risk factors associated with heart failure in epidemiological studies from classic smoking and hypertension as risk factors for ischemic heart disease and heart failure with reduced ejection fraction, to morbid obesity, diabetes mellitus, and metabolic syndrome in the aging population as risk factors for heart failure with preserved ejection failure [5]