沙库巴曲缬沙坦应用于心血管疾病研究进展

Research progress of sacubitril valsartan in cardiovascular diseases

心力衰竭是各种心血管疾病的严重和终末阶段,致残致死性高,严重威胁人类的健康。据估计,中国目前拥有超过1 000万的心衰病人。尽管近20年来慢性收缩性心力衰竭一直使用血管紧张素转换酶抑制剂(ACEI)、血管紧张素II受体拮抗剂(ARB)、β受体阻断剂和醛固酮受体拮抗剂为主药物治疗,但心力衰竭在全球范围内发病率、死亡率和医疗保健支出均呈升高趋势。对更高效医疗的要求以及生物医学创新的发展,血管紧张素受体脑啡肽酶抑制剂(ARNI)--沙库巴曲缬沙坦(诺欣妥)应运而生。PARADIGM-HF研究是在射血分数降低的心力衰竭病人中与依那普利对比,提供了沙库巴曲缬沙坦在心血管和全因死亡中获益的有力证据。而对射血分数保留的心力衰竭、高血压及其亚组、肺动脉高压、心肌梗死、糖尿病和肾脏疾病的临床研究表明,沙库巴曲缬沙坦对各种心血管疾病均能获益。沙库巴曲缬沙坦在心血管疾病治疗中显现出巨大的前景。

Heart failure(HF)is a serious and terminal stage of various cardiovascular diseases,with high disability and lethality,which seriously threatens human health.It is estimated that China currently has more than 10 million patients with heart failure.Despite the use of guideline-directed medical therapies such as angiotensin-converting enzyme inhibitors(ACEI),angiotensin receptor blockers(ARB),beta-adrenergic blockers and mineralocorticoid receptor antagonists for chronic systolic HF for almost two decades,HF has an increasing trend in morbidity,mortality and health care expenditures worldwide.A requirement for more efficient medical therapies coupled with recent advances in bio-innovation led to the creation of sacubitril valsartan(Entresto),an angiotensin receptor neprilysin inhibitor(ARNI).PARADIGM-HF trial provided compelling evidence for the cardiovascular and all-cause mortality benefit of sacubitril valsartan when compared to enalapril in patients with heart failure and reduced ejection fraction(HFrEF).While clinical studies in HF with preserved ejection fraction(HFpEF),hypertension and subsets,pulmonary hypertension,myocardial infarction,diabetes mellitus and renal disease suggested that sacubitril valsartan could be beneficial across a wide spectrum of cardiovascular disease.Sacubitril valsartan has shown great prospects in the treatment of cardiovascular diseases.