The effects of sacubitril/valsartan on coronary outcomes in PARADIGM-HF

Mogensen, U. M. et al. (2017) The effects of sacubitril/valsartan on coronary outcomes in PARADIGM-HF. American Heart Journal, 188, pp. 35-41. (doi: 10.1016/j.ahj.2017.02.034) (PMID:28577679)

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Background: Angiotensin converting enzyme inhibitors (ACE-I), are beneficial both in heart failure with reduced ejection fraction (HF-REF) and after myocardial infarction (MI). We examined the effects of the angiotensin-receptor neprilysin inhibitor sacubitril/valsartan, compared with the ACE-I enalapril, on coronary outcomes in PARADIGM-HF. Methods and results: We examined the effect of sacubitril/valsartan compared with enalapril on the following outcomes: i) the primary composite endpoint of cardiovascular (CV) death or HF hospitalization, ii) a pre-defined broader composite including, in addition, MI, stroke, and resuscitated sudden death, and iii) a post hoc coronary composite of CV-death, non-fatal MI, angina hospitalization or coronary revascularization. At baseline, of 8399 patients, 3634 (43.3%) had a prior MI and 4796 (57.1%) had a history of any coronary artery disease. Among all patients, compared with enalapril, sacubitril/valsartan reduced the risk of the primary outcome (HR 0.80 [0.73–0.87], P < .001), the broader composite (HR 0.83 [0.76–0.90], P < .001) and the coronary composite (HR 0.83 [0.75–0.92], P < .001). Although each of the components of the coronary composite occurred less frequently in the sacubitril/valsartan group, compared with the enalapril group, only CV death was reduced significantly. Conclusions: Compared with enalapril, sacubitril/valsartan reduced the risk of both the primary endpoint and a coronary composite outcome in PARADIGM-HF. Additional studies on the effect of sacubitril/valsartan on atherothrombotic outcomes in high-risk patients are merited.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Jhund, Dr Pardeep and Mogensen, Dr Ulrik and McMurray, Professor John
Authors: Mogensen, U. M., Køber, L., Kristensen, S. L., Jhund, P. S., Gong, J., Lefkowitz, M. P., Rizkala, A. R., Rouleau, J. L., Shi, V. C., Swedberg, K., Zile, M. R., Solomon, S. D., Packer, M., and McMurray, J. J.V.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:American Heart Journal
ISSN (Online):1097-6744
Published Online:14 March 2017

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