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Our research group focuses on neuropeptides and neuromodulators that influence cardiovascular autonomic control as potential biomarkers in disease and tractable targets for therapeutic intervention. Acute myocardial infarction (AMI) and chronic heart failure (CHF) result in high levels of cardiac sympathetic stimulation, which is a poor prognostic indicator. Although beta\u2010blockers improve mortality in these conditions by preventing the action of the neurotransmitter noradrenaline, a substantial residual risk remains. Recently, we have identified the sympathetic co\u2010transmitter neuropeptide\u2010Y (NPY) as being released during AMI, leading to larger infarcts and life\u2010threatening arrhythmia in both animal models and patients. Here, we discuss recently published data demonstrating that peripheral venous NPY levels are associated with heart failure hospitalisation and mortality after AMI, and all cause cardiovascular mortality in CHF, even when adjusting for known risk factors (including brain natriuretic peptide). We have investigated the mechanistic basis for these observations in human and rat stellate ganglia and cardiac tissue, manipulating NPY neurochemistry at the same time as using state\u2010of\u2010the\u2010art imaging techniques, to establish the receptor pathways responsible for NPY signalling. We propose NPY as a new mechanistic biomarker in AMI and CHF patients and aim to determine whether specific NPY receptor blockers can prevent arrhythmia and attenuate the development of heart failure.\n<jats:boxed-text content-type=\"graphic\" position=\"anchor\"><jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/tjp16100-gra-0001-m.png\"><jats:alt-text>image<\/jats:alt-text><\/jats:graphic><\/jats:boxed-text><\/jats:p>","DOI":"10.1113\/jp285370","type":"journal-article","created":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T12:10:25Z","timestamp":1717762225000},"page":"1841-1864","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Bayliss Starling Prize Lecture 2023: Neuropeptide\u2010Y being \u2018unsympathetic\u2019 to the broken hearted"],"prefix":"10.1113","volume":"603","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3343-2590","authenticated-orcid":false,"given":"Benjamin","family":"Bussmann","sequence":"first","affiliation":[{"name":"Burdon Sanderson Cardiac Science Centre, Department of Physiology, Anatomy and Genetics University of Oxford  Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thamali","family":"Ayagama","sequence":"additional","affiliation":[{"name":"Burdon Sanderson Cardiac Science Centre, Department of Physiology, Anatomy and Genetics University of Oxford  Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kun","family":"Liu","sequence":"additional","affiliation":[{"name":"Burdon Sanderson Cardiac Science Centre, Department of Physiology, Anatomy and Genetics University of Oxford  Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2230-9300","authenticated-orcid":false,"given":"Dan","family":"Li","sequence":"additional","affiliation":[{"name":"Burdon Sanderson Cardiac Science Centre, Department of Physiology, Anatomy and Genetics University of Oxford  Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8453-6133","authenticated-orcid":false,"given":"Neil","family":"Herring","sequence":"additional","affiliation":[{"name":"Burdon Sanderson Cardiac Science Centre, Department of Physiology, Anatomy and Genetics University of Oxford  Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,6,7]]},"reference":[{"issue":"3","key":"e_1_2_2_2_1","first-page":"318","article-title":"Coronary sinus neuropeptide Y levels and adverse outcomes in patients with stable chronic heart failure","volume":"5","author":"Ajijola O. 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