Korean Circ J.  2019 Jun;49(6):469-484. 10.4070/kcj.2019.0136.

Sacubitril/Valsartan in Asian Patients with Heart Failure with Reduced Ejection Fraction

• Dewan P
• Docherty K
• McMurray J

• KMID: 2454042
• DOI: http://doi.org/10.4070/kcj.2019.0136

Abstract

The Prospective comparison of Angiotensin Receptor-neprilysin inhibitor (ARNI) with Angiotensin converting enzyme inhibitor (ACEI) to Determine Impact on Global Mortality and morbidity in Heart Failure (HF) trial (PARADIGM-HF) showed that adding a neprilysin inhibitor (sacubitril) to a renin-angiotensin system blocker (and other standard therapy) reduced morbidity and mortality in ambulatory patients with chronic HF with reduced ejection fraction (HFrEF). In PARADIGM-HF, valsartan combined with sacubitril (a so-called ARNI) was superior to the current gold standard of an ACEI, specifically enalapril, reducing the risk of the primary composite outcome of cardiovascular (CV) death or first HF hospitalization by 20% and all-cause death by 16%. Following the results of PARADIGM-HF, sacubitril/valsartan was approved by American and European regulatory authorities for the treatment of HFrEF. The burden of HF in Asia is substantial, both due to the huge population of the region and as a result of increasing CV risk factors and disease. Both the prevalence and mortality associated with HF are high in Asia. In the following review, we discuss the development of sacubitril/valsartan, the prototype ARNI, and the available evidence for its efficacy and safety in Asian patients with HFrEF.

Keyword

Asians; Sacubitril/valsartan; Heart failure

MeSH Terms

Angiotensins
Asia
Asian Continental Ancestry Group*
Enalapril
Heart Failure*
Heart*
Hospitalization
Humans
Mortality
Neprilysin
Peptidyl-Dipeptidase A
Prevalence
Prospective Studies
Renin-Angiotensin System
Risk Factors
Valsartan
Angiotensins
Enalapril
Neprilysin
Peptidyl-Dipeptidase A
Valsartan

Figure

• 

  Figure 1 Number of patients of Asian patients by region enrolled in PARADIGM-HF (Asian race only). PARADIGM-HF = Prospective comparison of Angiotensin Receptor-neprilysin inhibitor with Angiotensin converting enzyme inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure trial.

• 

  Figure 2 Event rates per 100 patient years by treatment in all patients and by Asian regions enrolled in PARADIGM-HF. HF = heart failure; PARADIGM-HF = Prospective comparison of Angiotensin Receptor-neprilysin inhibitor with Angiotensin converting enzyme inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure trial.

• 

  Figure 3 Treatment effects by Asian regions in PARADIGM-HF. CI = confidence interval; PARADIGM-HF = Prospective comparison of Angiotensin Receptor-neprilysin inhibitor with Angiotensin converting enzyme inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure trial. *Interaction p value for Asia subgroups.

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