Muthiah Vaduganathan, cardiologist: "Women have symptoms of cardiovascular disease that are often overlooked"

An expert explains why kidney disease and heart disease benefit from the same treatment

Muthiah Vaduganathan, cardiologist: "Women show symptoms that are often overlooked in cardiovascular diseases"

The expert explains why kidney disease and heart failure benefit from the same treatments

April 6, 2026 Updated 05:00 Kidney and heart are traditionally understood as separate entities with related expertise in the health field.But there are many signs that indicate a close relationship between the two members, which cannot be ignored.So much so that pathologies such as heart failure and chronic kidney disease share an important part of the risk factors and often occur together in the same patient.This led experts such as cardiologist Muthiah Vaduganathan, to conclude that adequate treatment for one of the two diseases can be beneficial for the other.This is what happens with treatments such as finerenone.As part of the Bayer Pharma Media Day held in Berlin, La Voz de la Salud spoke to an expert, co-director of the Center for Cardiometabolic Science Implementation at Brigham and Women's Hospital and professor at Harvard Medical School.Together with a doctor in the field of biomedical engineering and the world's chief medical officer in the field of heart failure at Bayer Lucas Hofmeister, he examines the close relationship between the heart and the kidney, the problems in diagnosis and the future of joint treatment of both diseases.

- What is the relationship between heart disease and kidneys?How does kidney function affect the progression of heart disease?

-Muthia Vaduganathan: A heart attack, especially when the heart does not fill or pump properly, reduces blood flow to the kidneys.When the kidneys detect this deficiency, they release substances into the bloodstream that act as warning signals to the heart, indicating that something is not right.In this case, they lose the ability to properly eliminate liquids, water and salt, which causes retention.This creates a vicious cycle in which the heart and kidneys together begin to fail, one impairing the function of the other.The result is fluid buildup and congestion, which often leads to hospitalization. In fact, it is one of the most important complications of heart failure and the leading cause of hospitalization in older people worldwide.

- Lucas Hofmeister: We also see this connection on an epidemiological level, as more than 40% of heart failure patients have kidney disease and vice versa.Both share risk factors such as obesity, smoking, poor diet or alcohol, and treatment for both is similar.

- There are large numbers of patients with unmet needs and symptoms that are sometimes neglected.Where does the current approach fail?

——M.V.: Many patients are older and suffer from other medical conditions, so symptoms such as shortness of breath, leg swelling, or fatigue are often related to aging. Physicians should recognize these symptoms and use early diagnostic tools, such as biomarkers called natriuretic peptides, or imaging tests, such as echocardiography to assess the structure and function of the heart and calculate the internal pressure caused by excess fluid.

—Are there populations that are more susceptible to this duo of diseases?

-M.V.: Yes. People with limited access to health care, for example in rural areas, have a greater risk of being undiagnosed, which worsens their condition.Racial, socioeconomic, and ethnic disparities also exist in many countries.And women tend to have symptoms that are often overlooked in cardiovascular disease.

—Is this because symptoms differ in women or because these patients are neglected by the health system?

— M.V.: It's a combination of both.Manifestations can be slightly different and women describe their symptoms differently than men, even in combination.However, there is also a clinical bias and heart disease in women is often undiagnosed or treated ineffectively.

- How do they usually describe each other's symptoms?

—M.V.: Women are more likely than men to have respiratory problems, which are often mistaken for anxiety or panic attacks, delaying correct diagnosis.

- How has research changed the landscape of these diseases?

- M.V.: At the moment, we are in a kind of recovery at the therapeutic level.In the case of heart failure with a preserved ejection fraction, which is one of the most common types of pathology, there were very few options before, and now we have many effective treatment methods.Interestingly, many of the treatments that work for the heart also work for the kidneys, indicating that the two diseases share a common biological basis.

-LH.: For many years, the main treatment was diuretics to relieve congestion in the myocardium; but these treatments do not affect the cause, so they do not correct the condition in the end.Today, we are moving toward treatments that address the causes, not just the symptoms.

-Do these new drugs improve survival?

-M.V: It has been shown in clinical trials to improve survival without events, which means that they live longer without hospitalization.The current challenge is to implement these treatments early and widely in clinics to achieve the same benefits at the population level.

- What is the role of early diagnosis?

- M.V.: There is still a big gap.We've come a long way in the last decade, but as awareness grows, we're finding more and more cases.We must not only diagnose the undiagnosed, but do so in the early stages of the disease.

- Many patients use several medications for other diseases.Does this affect the effectiveness of the treatments?

—M.V.: It is true that these patients usually have multiple medications; Many times we find people who use ten to fifteen drugs, many of which are not related to the heart or kidneys.But adding evidence-based treatment has always been shown to be safe and effective.Not only that, but some of these new drugs make it possible to reduce the dose or even withdraw other drugs by improving parameters such as blood pressure, glucose or body weight.

- How does this new treatment work?

—M.V.: Some people directly affect the balance of sodium and water in the body, leading to weight loss.Affects other hormone receptors involved in blood pressure regulation and helps control it.

Where does the future go in heart-kidney combination therapy?

— M. V.: Ideally, these fields will continue to converge.I believe that there will always be a need for both specialties, cardiology and nephrology, to deal with specific diseases, but most heart and kidney diseases are complex and require a joint approach.

- L.H.: We also have to take into account the lack of specialists in many areas.That's why it's so important to train primary care and internal medicine physicians on these topics, as these patients come before and more often than we do.Early intervention is essential to prevent complications requiring hospitalization.