This study evaluated the association between leukocyte telomere length (LTL), a marker of biological aging, and various cardiovascular imaging traits and heart failure risk in middle-aged adults. Longer LTL, which is associated with a lower risk of cardiovascular disease, was independently associated with positive cardiac remodeling, including higher left ventricular mass, larger ventricular size and volume, and higher stroke volumes. Participants with the longest LTL had a 14% lower risk of developing heart failure during follow-up compared to those with the shortest LTL. Genetic analyses also suggested a potential causal link between a longer LTL and larger heart size and volume. In conclusion, longer LTL was associated with a larger but better-functioning heart in middle age, which may help explain the observed lower risk of heart failure. These findings suggest that LTL may be a marker of cardiovascular health and aging.

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