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Vericiguat in Heart Failure with a Reduced Ejection Fraction: Patient Selection and Special Considerations
With improvement in the understanding of the pathophysiological mechanisms of heart failure with reduced ejection fraction (HFrEF), several drug classes have been developed targeting the renin–angiotensin–aldosterone system, the beta adrenergic system, and to a certain extent the nitric oxide pathwa...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dove
2022
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8977472/ https://www.ncbi.nlm.nih.gov/pubmed/35386181 http://dx.doi.org/10.2147/TCRM.S357422 |
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author | Kassis-George, Hayah Verlinden, Nathan J Fu, Sheng Kanwar, Manreet |
author_facet | Kassis-George, Hayah Verlinden, Nathan J Fu, Sheng Kanwar, Manreet |
author_sort | Kassis-George, Hayah |
collection | PubMed |
description | With improvement in the understanding of the pathophysiological mechanisms of heart failure with reduced ejection fraction (HFrEF), several drug classes have been developed targeting the renin–angiotensin–aldosterone system, the beta adrenergic system, and to a certain extent the nitric oxide pathway. Recently, the use of sodium-glucose cotransporter-2 (SGLT-2) inhibitors has resulted in a reduction in heart failure hospitalizations and cardiovascular death. As a result, SGLT-2 inhibitors are now the fourth drug class recommended as part of guideline-directed medical therapy (GDMT) for HFrEF. Soluble guanylate cyclase (sGC) stimulators, such as vericiguat, are a novel therapy targeting the cyclic guanosine monophosphate (cGMP) pathway with downstream effects including smooth muscle cell relaxation and a reduction in hypertrophy, inflammation, and fibrosis. The recently published VICTORIA trial has demonstrated a reduction in heart failure hospitalizations or cardiovascular death with vericiguat. Patients with a baseline N-terminal pro-B-type natriuretic peptide (NT-proBNP) values <8000 pg/mL may identify a sub-group most likely to benefit with addition of vericiguat. The cumulative benefit of quadruple therapy with the addition of sGC stimulators remains unknown. We review the mechanism of action for sGC stimulators, clinical trial data, and their real-world application to HFrEF patients with consideration of quintuple therapy. |
format | Online Article Text |
id | pubmed-8977472 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Dove |
record_format | MEDLINE/PubMed |
spelling | pubmed-89774722022-04-05 Vericiguat in Heart Failure with a Reduced Ejection Fraction: Patient Selection and Special Considerations Kassis-George, Hayah Verlinden, Nathan J Fu, Sheng Kanwar, Manreet Ther Clin Risk Manag Review With improvement in the understanding of the pathophysiological mechanisms of heart failure with reduced ejection fraction (HFrEF), several drug classes have been developed targeting the renin–angiotensin–aldosterone system, the beta adrenergic system, and to a certain extent the nitric oxide pathway. Recently, the use of sodium-glucose cotransporter-2 (SGLT-2) inhibitors has resulted in a reduction in heart failure hospitalizations and cardiovascular death. As a result, SGLT-2 inhibitors are now the fourth drug class recommended as part of guideline-directed medical therapy (GDMT) for HFrEF. Soluble guanylate cyclase (sGC) stimulators, such as vericiguat, are a novel therapy targeting the cyclic guanosine monophosphate (cGMP) pathway with downstream effects including smooth muscle cell relaxation and a reduction in hypertrophy, inflammation, and fibrosis. The recently published VICTORIA trial has demonstrated a reduction in heart failure hospitalizations or cardiovascular death with vericiguat. Patients with a baseline N-terminal pro-B-type natriuretic peptide (NT-proBNP) values <8000 pg/mL may identify a sub-group most likely to benefit with addition of vericiguat. The cumulative benefit of quadruple therapy with the addition of sGC stimulators remains unknown. We review the mechanism of action for sGC stimulators, clinical trial data, and their real-world application to HFrEF patients with consideration of quintuple therapy. Dove 2022-03-30 /pmc/articles/PMC8977472/ /pubmed/35386181 http://dx.doi.org/10.2147/TCRM.S357422 Text en © 2022 Kassis-George et al. https://creativecommons.org/licenses/by-nc/3.0/This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/ (https://creativecommons.org/licenses/by-nc/3.0/) ). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). |
spellingShingle | Review Kassis-George, Hayah Verlinden, Nathan J Fu, Sheng Kanwar, Manreet Vericiguat in Heart Failure with a Reduced Ejection Fraction: Patient Selection and Special Considerations |
title | Vericiguat in Heart Failure with a Reduced Ejection Fraction: Patient Selection and Special Considerations |
title_full | Vericiguat in Heart Failure with a Reduced Ejection Fraction: Patient Selection and Special Considerations |
title_fullStr | Vericiguat in Heart Failure with a Reduced Ejection Fraction: Patient Selection and Special Considerations |
title_full_unstemmed | Vericiguat in Heart Failure with a Reduced Ejection Fraction: Patient Selection and Special Considerations |
title_short | Vericiguat in Heart Failure with a Reduced Ejection Fraction: Patient Selection and Special Considerations |
title_sort | vericiguat in heart failure with a reduced ejection fraction: patient selection and special considerations |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8977472/ https://www.ncbi.nlm.nih.gov/pubmed/35386181 http://dx.doi.org/10.2147/TCRM.S357422 |
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