Cardiovascular disease (CVD) represents a substantial global health and economic burden, particularly the major end-stage manifestation: congestive heart failure (CHF). CHF is a complex, multifaceted clinical syndrome defined by inadequate cardiac output owing to inefficient and/or abnormal cardiac performance. CHF prevalence has risen steadily, driven in part by the global ageing population. Despite advances and increased availability in treatment options, CHF is still associated with a high mortality and approximately 50% of patients die within 5 years of the CHF diagnosis.

With the aim of characterizing the epidemiology of CVD, the US Public Health Service established the Framingham Heart Study in 1948. This longitudinal, multigenerational study fundamentally transformed the global understanding of CVD by highlighting how both modifiable (cholesterol, smoking and obesity) and non-modifiable (age, genetics and sex) factors influence the development and progression of CVD. These findings instigated a paradigm shift towards prevention versus treatment of acute symptoms. One prominent CVD risk factor identified in the Framingham Heart Study was diabetes mellitus, which culminated in the publication of the seminal 1974 article by William Kannel and colleagues on the role of diabetes in CHF. Before this publication, the link between diabetes and CVD was recognized but poorly understood, and lacked robust evidence to define causality.