Efficacy of sacubitril / valsartan in the treatment of chronic heart failure: an updated review

Abstract

Chronic heart failure (CHF) is currently a common disease and the search for new approaches to the treatment of various forms of CHF remains relevant. Sacubitril/valsartan is a member of a new class of angiotensin-neprilysin receptor inhibitors (ARNIs) that act on key neurohormonal mechanisms, including the RAAS and natriuretic peptides. Simultaneous inhibition of RAAS and neprilysin provides more effective neurohormonal modulation, preventing clinical deterioration in patients with CHF. New mechanisms of action of sacubitril/valsartan associated with the inhibition of several targets involved in cardiac hypertrophy, fibrosis, cardiac remodeling and apoptosis have been disclosed. Sacubitril/valsartan is recommended for CHF with low ejection fraction (EF) in addition to traditional therapy with ACE inhibitors, mineralocorticoid receptor antagonists, beta-blockers, and also has an independent effect. A number of studies have shown the effect of sacubitril/valsartan on heart remodeling, a decrease in the level of the NT-proBNP biomarker and an improvement in EF, and according to the PARADIGM-HF study, the drug significantly reduced the risk of cardiovascular mortality by 20% and hospitalizations for CHF by 21%, which found confirmation in three meta-analyses. The use of sacubitril/valsartan in CHF with preserved and intermediate EF showed a beneficial therapeutic effect and a decrease in the level of biomarkers, as well as a significant decrease in the frequency of hospitalizations due to CHF by 15–22%, but without a significant advantage in terms of the effect on mortality, which supported by several meta-analyses of studies. A number of large meta-analyses of studies of sacubitril/valsartan in CHF have shown reverse cardiac remodeling and a reduced risk of atrial fibrillation. Thus, the accumulated data substantiate and expand the possibilities of using sacu-bitril/valsartan in CHF.