Sacubitril/valsartan in cardiovascular disease: evidence to date and place in therapy

Ther Adv Cardiovasc Dis. 2018 Aug;12(8):217-231. doi: 10.1177/1753944718784536. Epub 2018 Jun 19.

Abstract

Cardiovascular (CV) disease is a major cause of morbidity and mortality in the developing and the developed world. Mortality from CV disease had plateaued in the recent years raising concerning alarms about the sustained efficacy of available preventive and treatment options. Heart failure (HF) is among the major contributors to the CV-related health care burden, a persisting concern despite the use of clinically proven guideline-directed therapies. A requirement for more efficient medical therapies coupled with recent advances in bio-innovation led to the creation of sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNI), which demonstrated substantial CV benefit when compared with the standard of care, enalapril, in patients with HF and reduced ejection fraction. Further investigations of this novel combination ARNI at the tissue level shed light into the anti-remodeling and cardioprotective effects of sacubitril/valsartan, while clinical studies in the phenotypes of HF with preserved ejection fraction, hypertension and subsets, coronary outcomes, postmyocardial infarction, and renal disease suggested that this combination could be beneficial across a wide spectrum of CV disease. Sacubitril/valsartan is a much-needed therapeutic advance in the avenue of CV disease.

Keywords: Entresto; LCZ696; PARADIGM-HF; cardiovascular disease; heart failure; heart failure with reduced ejection fraction; sacubitril/valsartan.

Publication types

  • Review

MeSH terms

  • Aminobutyrates / adverse effects
  • Aminobutyrates / therapeutic use*
  • Angiotensin II Type 1 Receptor Blockers / adverse effects
  • Angiotensin II Type 1 Receptor Blockers / therapeutic use*
  • Animals
  • Biphenyl Compounds
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / drug therapy*
  • Cardiovascular Diseases / mortality
  • Cardiovascular Diseases / physiopathology
  • Drug Combinations
  • Female
  • Hemodynamics / drug effects
  • Humans
  • Male
  • Middle Aged
  • Neprilysin / antagonists & inhibitors*
  • Protease Inhibitors / adverse effects
  • Protease Inhibitors / therapeutic use*
  • Recovery of Function
  • Stroke Volume / drug effects
  • Tetrazoles / adverse effects
  • Tetrazoles / therapeutic use*
  • Treatment Outcome
  • Valsartan
  • Ventricular Function, Left / drug effects

Substances

  • Aminobutyrates
  • Angiotensin II Type 1 Receptor Blockers
  • Biphenyl Compounds
  • Drug Combinations
  • Protease Inhibitors
  • Tetrazoles
  • Valsartan
  • Neprilysin
  • sacubitril and valsartan sodium hydrate drug combination