Rajzer Przemyslaw, Biegus Jan
University of Glasgow School of Medicine, Glasgow, Scotland, UK.
Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
Heart Fail Rev. 2025 Mar;30(2):387-405. doi: 10.1007/s10741-024-10471-1. Epub 2025 Jan 7.
Heart failure (HF) represents a significant global health challenge, characterized by high morbidity and mortality rates, decreased quality of life and a significant financial and economic burden. The prevalence of HF continues to rise, driven by an ageing population and an increasing burden of comorbidities such as hypertension, diabetes and obesity. Understanding the complex pathophysiology and developing effective treatments are critical for improving patient outcomes, yet the range of effective, life-prolonging medication classes has remained mostly constant in the last few decades. The introduction of angiotensin receptor neprilysin inhibitors (ARNI) was a major breakthrough in HF management, for the first time targeting the natriuretic peptide system in addition to the renin-angiotensin-aldosterone pathway to potentiate the effects of older drug classes. ARNI shows superiority in clinical outcomes compared to previous guideline-directed therapies, especially in patients with reduced ejection fraction (EF). It has now been implemented into international guidelines, endorsing its use in patients with HF and reduced ejection fraction (HFrEF) and HF with mildly reduced ejection fraction (HFmrEF). This review summarises the mechanism of action of Sac/Val, presents key clinical trials in a range of patient populations and HF aetiologies and outlines gaps in knowledge and potential novel uses of Sac/Val.
心力衰竭(HF)是一项重大的全球健康挑战,其特征为高发病率和死亡率、生活质量下降以及巨大的财政和经济负担。受人口老龄化以及高血压、糖尿病和肥胖等合并症负担增加的推动,HF的患病率持续上升。了解复杂的病理生理学并开发有效的治疗方法对于改善患者预后至关重要,然而在过去几十年中,有效的延长生命的药物类别范围基本保持不变。血管紧张素受体脑啡肽酶抑制剂(ARNI)的引入是HF管理中的一项重大突破,它除了作用于肾素-血管紧张素-醛固酮途径外,首次靶向利钠肽系统,以增强旧有药物类别的效果。与先前的指南指导疗法相比,ARNI在临床结局方面显示出优越性,尤其是在射血分数(EF)降低的患者中。它现已被纳入国际指南,批准用于射血分数降低的心力衰竭(HFrEF)患者和射血分数轻度降低的心力衰竭(HFmrEF)患者。本综述总结了沙库巴曲缬沙坦的作用机制,介绍了一系列患者群体和HF病因的关键临床试验,并概述了知识空白以及沙库巴曲缬沙坦的潜在新用途。