Department of Clinical Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
Cardiology Division, ICOT Istituto "Marco Pasquali" University Hospital, Latina, Italy.
Am J Cardiovasc Drugs. 2024 Jul;24(4):469-479. doi: 10.1007/s40256-024-00652-6. Epub 2024 Jun 10.
Heart failure with reduced ejection fraction (HFrEF) represents an emerging epidemic, particularly affecting frail, older, and multimorbid patients. Current therapy for the management of HFrEF includes four different classes of disease-modifying drugs, commonly referred to as 'four pillars', which target the neurohormonal system that is overactivated in HF and contributes to its progression. These classes of drugs include β-blockers, inhibitors of the renin-angiotensin-aldosterone system, mineralocorticoid receptor antagonists, and sodium-glucose co-transporter-2 (SGLT2) inhibitors. Unfortunately, these agents cannot be administered as frequently as needed to older patients because of poor tolerability and comorbidities. In addition, although these drugs have dramatically increased the survival expectations of patients with HF, their residual risk of rehospitalization and death at 5 years remains considerable. Vericiguat, a soluble guanylate cyclase (sGC) stimulator, was reported to exert beneficial effects in patients with worsening HF, including older subjects, reducing the rate of both hospitalizations and deaths, with limited adverse effects and drug interaction. In this narrative review, we present the current state of art on vericiguat, with a particular focus on elderly and frail patients.
射血分数降低的心力衰竭（HFrEF）是一种正在出现的流行疾病，尤其影响体弱、年老和多病的患者。目前治疗 HFrEF 的方法包括四类疾病修正药物，通常称为“四大支柱”，它们针对在心力衰竭中过度激活并导致其进展的神经激素系统。这些类别的药物包括β受体阻滞剂、肾素-血管紧张素-醛固酮系统抑制剂、盐皮质激素受体拮抗剂和钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂。不幸的是，由于耐受性差和合并症，这些药物不能像需要的那样频繁地用于老年患者。此外，尽管这些药物显著提高了心力衰竭患者的生存预期，但他们在 5 年内再次住院和死亡的残余风险仍然相当大。可溶性鸟苷酸环化酶（sGC）刺激剂维立西呱在心力衰竭恶化的患者中表现出有益作用，包括老年患者，降低了住院和死亡的发生率，且不良反应和药物相互作用有限。在这篇叙述性综述中，我们介绍了维立西呱的最新研究进展，特别关注老年和体弱患者。
