In summary, it has been demonstrated that asymptomatic patients with elevated NP levels are at higher risk of heart failure and other cardiovascular events. Elevated NP in this setting represents a protective, endogenous response to fibro-inflammation. The predominant cardiac abnormality in these patients is ALVDD, which can be tracked using LAVI. The hypothesis is that augmenting this protective fibro-inflammatory response with LCZ696 could demonstrate superiority over the current state of art therapy in patients with hypertension or diabetes and elevated NP in a phase II study design and, in doing so, PARABLE may deliver a major clinical innovation in the prevention of cardiovascular disease.