Patel RB, Colangelo LA, Bielinski SJ, et al. - To clarify the prospective link of vascular cell adhesion molecule‐1 (VCAM‐1) with occurrence of clinically overt heart failure (HF) across ejection fraction categories, researchers examined the link of VCAM‐1 at examination 2 (2002–2004) with incident HF [HFpEF (heart failure with preserved ejection fraction) and HF with reduced ejection fraction] following adjustment for cardiovascular risk factors in the Multi‐Ethnic Study of Atherosclerosis. Following covariate adjustment, each doubling of VCAM‐1 was found to be related to incident HF. This link seemed stronger in current/former smokers vs never smokers. Assessment of HF subtypes revealed a link of VCAM‐1 with incident HFpEF but not with incident HF with reduced ejection fraction, although risk estimates were shown to be consistent. Overall, a long‐term follow‐up of a multiethnic cohort demonstrated a significant association of VCAM‐1 with incident HF. According to these findings, endothelial activation has a potential role in driving clinical HF, and particularly HFpEF. The progression from cardiovascular risk factors to clinical HF may be averted by therapies that reduce endothelial activation.