Department of Medicine, University of São Paulo Medical School, São Paulo, Brazil.
Curitiba Heart Institute (INCOR Curitiba) and Denton Cooley Institute of Research Science and Technology,Curitiba, Paraná, Brazil.
Am J Cardiol. 2023 Oct 15;205:259-268. doi: 10.1016/j.amjcard.2023.07.154. Epub 2023 Aug 22.
Sacubitril-valsartan is an angiotensin receptor-neprilysin inhibitor (ARNI) associated with a decreased risk of death and hospitalization for selected patients with heart failure (HF). However, its association with improved atherosclerotic cardiovascular disease (ASCVD) events remains unclear. We performed a meta-analysis to evaluate the association of ARNI with ASCVD events in patients with HF. We systematically searched PubMed, Embase, Cochrane, and ClinicalTrials.gov for studies comparing ARNIs with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in terms of myocardial infarction, stroke, angina pectoris, peripheral artery disease, and the composite end point in patients with HF. A total of 8 randomized controlled trials were included, with 17,541 patients assigned to either the ARNI (8,764 patients) or ACEi/ARB (8,777 patients) groups. The incidence of composite end point (risk ratio [RR] 1.03, 95% confidence interval [CI] 0.93 to 1.13, p = 0.63), myocardial infarction (RR 1.02, 95% CI 0.81 to 1.30, p = 0.85), angina pectoris (RR 0.96, 95% CI 0.80 to 1.17, p = 0.70), and stroke (RR 0.99, 95% CI 0.85 to 1.16, p = 0.93) were not statistically different between the ARNI and ACEi/ARB groups. However, ARNI was associated with a higher incidence of peripheral artery disease (RR 1.63, 95% CI 1.05 to 2.52, p = 0.03). In conclusion, this meta-analysis found no association between ARNI therapy and improved ASCVD events in patients with HF.
沙库巴曲缬沙坦是一种血管紧张素受体脑啡肽酶抑制剂（ARNI），可降低特定心力衰竭（HF）患者的死亡和住院风险。然而，其与改善动脉粥样硬化性心血管疾病（ASCVD）事件的关系尚不清楚。我们进行了一项荟萃分析，以评估 ARNI 与 HF 患者 ASCVD 事件的相关性。我们系统地检索了 PubMed、Embase、Cochrane 和 ClinicalTrials.gov，以评估 ARNI 与血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB）相比，在心肌梗死、中风、心绞痛、外周动脉疾病和 HF 患者的复合终点方面的疗效。共纳入 8 项随机对照试验，共有 17541 例患者被分配至 ARNI（8764 例）或 ACEI/ARB（8777 例）组。复合终点（风险比 [RR] 1.03，95%置信区间 [CI] 0.93 至 1.13，p=0.63）、心肌梗死（RR 1.02，95% CI 0.81 至 1.30，p=0.85）、心绞痛（RR 0.96，95% CI 0.80 至 1.17，p=0.70）和中风（RR 0.99，95% CI 0.85 至 1.16，p=0.93）的发生率在 ARNI 和 ACEI/ARB 组之间无统计学差异。然而，ARNI 与外周动脉疾病的发生率较高相关（RR 1.63，95% CI 1.05 至 2.52，p=0.03）。综上所述，这项荟萃分析发现，HF 患者的 ARNI 治疗与 ASCVD 事件的改善无关。
