Sacubitril-Valsartan, Clinical Benefits and Related Mechanisms of Action in Heart Failure With Reduced Ejection Fraction. A Review
Pascual-Figal, DA (Hospital Universitario Virgen de la Arrixaca (Múrcia))
Bayés-Genís, Antoni (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Beltrán-Troncoso, Paola (Hospital de Viladecans)
Caravaca Perez, Pedro (Hospital Universitario 12 de Octubre (Madrid))
Conde-Martel, Alicia (Hospital Universitario de Gran Canaria Dr. Negrín)
Crespo-Leiro, Maria Generosa (Complexo Hospitalario Universitario A Coruña (Galícia))
Delgado, Juan F. (Hospital Universitario 12 de Octubre (Madrid))
Díez, Javier (Universidad de Navarra)
Formiga, Francesc (Hospital Universitari de Bellvitge)
Manito, Nicolás (Hospital Universitari de Bellvitge)

Date:	2021
Abstract:	Heart failure (HF) is a clinical syndrome characterized by the presence of dyspnea or limited exertion due to impaired cardiac ventricular filling and/or blood ejection. Because of its high prevalence, it is a major health and economic burden worldwide. Several mechanisms are involved in the pathophysiology of HF. First, the renin-angiotensin-aldosterone system (RAAS) is over-activated, causing vasoconstriction, hypertension, elevated aldosterone levels and sympathetic tone, and eventually cardiac remodeling. Second, an endogenous compensatory mechanism, the natriuretic peptide (NP) system is also activated, albeit insufficiently to counteract the RAAS effects. Since NPs are degraded by the enzyme neprilysin, it was hypothesized that its inhibition could be an important therapeutic target in HF. Sacubitril/valsartan is the first of the class of dual neprilysin and angiotensin receptor inhibitors (ARNI). In patients with HFrEF, treatment with sacubitril/valsartan has demonstrated to significantly reduce mortality and the rates of hospitalization and rehospitalization for HF when compared to enalapril. This communication reviews in detail the demonstrated benefits of sacubitril/valsartan in the treatment of patients with HFrEF, including reduction of mortality and disease progression as well as improvement in cardiac remodeling and quality of life. The hemodynamic and organic effects arising from its dual mechanism of action, including the impact of neprilysin inhibition at the renal level, especially relevant in patients with type 2 diabetes mellitus, are also reviewed. Finally, the evidence on the demonstrated safety and tolerability profile of sacubitril/valsartan in the different subpopulations studied has been compiled. The review of this evidence, together with the recommendations of the latest clinical guidelines, position sacubitril/valsartan as a fundamental pillar in the treatment of patients with HFrEF.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Heart failure ; Heart failure with reduced ejection fraction ; Sacubitril/valsartan ; ARNI ; Neprilysin inhibition
Published in:	Frontiers in Cardiovascular Medicine, Vol. 8 (november 2021) , ISSN 2297-055X

DOI: 10.3389/fcvm.2021.754499
PMID: 34859070

21 p, 2.5 MB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
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