Yandrapalli Srikanth, Khan Mohammed Hasan, Rochlani Yogita, Aronow Wilbert S
Department of Internal Medicine, New York Medical College at Westchester Medical Center, Valhalla, NY, USA.
Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla, NY, USA.
Ther Adv Cardiovasc Dis. 2018 Aug;12(8):217-231. doi: 10.1177/1753944718784536. Epub 2018 Jun 19.
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.
心血管（CV）疾病是发展中国家和发达国家发病和死亡的主要原因。近年来，心血管疾病的死亡率趋于平稳，这引发了人们对现有预防和治疗方案持续有效性的担忧。心力衰竭（HF）是心血管相关医疗负担的主要促成因素之一，尽管采用了经临床验证的指南指导疗法，但仍是一个持续存在的问题。对更有效药物治疗的需求，再加上生物创新的最新进展，催生了沙库巴曲缬沙坦，一种血管紧张素受体脑啡肽酶抑制剂（ARNI），在射血分数降低的心力衰竭患者中，与标准治疗药物依那普利相比，它显示出显著的心血管益处。在组织水平对这种新型复方ARNI的进一步研究揭示了沙库巴曲缬沙坦的抗重塑和心脏保护作用，而在射血分数保留的心力衰竭、高血压及其亚组、冠状动脉结局、心肌梗死后和肾脏疾病等表型方面的临床研究表明，这种复方药物可能对广泛的心血管疾病有益。沙库巴曲缬沙坦是心血管疾病治疗领域急需的进展。
