The effects of sacubitril/valsartan on coronary outcomes in PARADIGM-HF

Ulrik M. Mogensen; Lars Køber; Søren L. Kristensen; Pardeep S. Jhund; Jianjian Gong; Martin P. Lefkowitz; Adel R. Rizkala; Jean L. Rouleau; Victor C. Shi; Karl Swedberg; Michael R. Zile; Scott D. Solomon; Milton Packer; John J.V. McMurray; PARADIGM-HF Investigators and Committees

doi:10.1016/j.ahj.2017.02.034

The effects of sacubitril/valsartan on coronary outcomes in PARADIGM-HF

Ulrik M. Mogensen, Lars Køber, Søren L. Kristensen, Pardeep S. Jhund, Jianjian Gong, Martin P. Lefkowitz, Adel R. Rizkala, Jean L. Rouleau, Victor C. Shi, Karl Swedberg, Michael R. Zile, Scott D. Solomon, Milton Packer, John J.V. McMurray^*, PARADIGM-HF Investigators and Committees

^*Corresponding author for this work

Department of Clinical Medicine

21 Citations (Scopus)

Abstract

Background Angiotensin converting enzyme inhibitors (ACE-I), are beneficial both in heart failure with reduced ejection fraction (HF-REF) and after myocardial infarction (MI). We examined the effects of the angiotensin-receptor neprilysin inhibitor sacubitril/valsartan, compared with the ACE-I enalapril, on coronary outcomes in PARADIGM-HF. Methods and results We examined the effect of sacubitril/valsartan compared with enalapril on the following outcomes: i) the primary composite endpoint of cardiovascular (CV) death or HF hospitalization, ii) a pre-defined broader composite including, in addition, MI, stroke, and resuscitated sudden death, and iii) a post hoc coronary composite of CV-death, non-fatal MI, angina hospitalization or coronary revascularization. At baseline, of 8399 patients, 3634 (43.3%) had a prior MI and 4796 (57.1%) had a history of any coronary artery disease. Among all patients, compared with enalapril, sacubitril/valsartan reduced the risk of the primary outcome (HR 0.80 [0.73–0.87], P < .001), the broader composite (HR 0.83 [0.76–0.90], P < .001) and the coronary composite (HR 0.83 [0.75–0.92], P < .001). Although each of the components of the coronary composite occurred less frequently in the sacubitril/valsartan group, compared with the enalapril group, only CV death was reduced significantly. Conclusions Compared with enalapril, sacubitril/valsartan reduced the risk of both the primary endpoint and a coronary composite outcome in PARADIGM-HF. Additional studies on the effect of sacubitril/valsartan on atherothrombotic outcomes in high-risk patients are merited.

Original language	English
Journal	American Heart Journal
Volume	188
Pages (from-to)	35-41
Number of pages	7
ISSN	0002-8703
DOIs	https://doi.org/10.1016/j.ahj.2017.02.034
Publication status	Published - Jun 2017

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Mogensen, U. M., Køber, L., Kristensen, S. L., Jhund, P. S., Gong, J., Lefkowitz, M. P., Rizkala, A. R., Rouleau, J. L., Shi, V. C., Swedberg, K., Zile, M. R., Solomon, S. D., Packer, M., McMurray, J. J. V., & PARADIGM-HF Investigators and Committees (2017). The effects of sacubitril/valsartan on coronary outcomes in PARADIGM-HF. American Heart Journal, 188, 35-41. https://doi.org/10.1016/j.ahj.2017.02.034

Mogensen, UM, Køber, L, Kristensen, SL, Jhund, PS, Gong, J, Lefkowitz, MP, Rizkala, AR, Rouleau, JL, Shi, VC, Swedberg, K, Zile, MR, Solomon, SD, Packer, M, McMurray, JJV & PARADIGM-HF Investigators and Committees 2017, 'The effects of sacubitril/valsartan on coronary outcomes in PARADIGM-HF', American Heart Journal, vol. 188, pp. 35-41. https://doi.org/10.1016/j.ahj.2017.02.034

@article{79df185a11b048c796538be22245ef26,

title = "The effects of sacubitril/valsartan on coronary outcomes in PARADIGM-HF",

abstract = "Background Angiotensin converting enzyme inhibitors (ACE-I), are beneficial both in heart failure with reduced ejection fraction (HF-REF) and after myocardial infarction (MI). We examined the effects of the angiotensin-receptor neprilysin inhibitor sacubitril/valsartan, compared with the ACE-I enalapril, on coronary outcomes in PARADIGM-HF. Methods and results We examined the effect of sacubitril/valsartan compared with enalapril on the following outcomes: i) the primary composite endpoint of cardiovascular (CV) death or HF hospitalization, ii) a pre-defined broader composite including, in addition, MI, stroke, and resuscitated sudden death, and iii) a post hoc coronary composite of CV-death, non-fatal MI, angina hospitalization or coronary revascularization. At baseline, of 8399 patients, 3634 (43.3%) had a prior MI and 4796 (57.1%) had a history of any coronary artery disease. Among all patients, compared with enalapril, sacubitril/valsartan reduced the risk of the primary outcome (HR 0.80 [0.73–0.87], P < .001), the broader composite (HR 0.83 [0.76–0.90], P < .001) and the coronary composite (HR 0.83 [0.75–0.92], P < .001). Although each of the components of the coronary composite occurred less frequently in the sacubitril/valsartan group, compared with the enalapril group, only CV death was reduced significantly. Conclusions Compared with enalapril, sacubitril/valsartan reduced the risk of both the primary endpoint and a coronary composite outcome in PARADIGM-HF. Additional studies on the effect of sacubitril/valsartan on atherothrombotic outcomes in high-risk patients are merited.",

author = "Mogensen, {Ulrik M.} and Lars K{\o}ber and Kristensen, {S{\o}ren L.} and Jhund, {Pardeep S.} and Jianjian Gong and Lefkowitz, {Martin P.} and Rizkala, {Adel R.} and Rouleau, {Jean L.} and Shi, {Victor C.} and Karl Swedberg and Zile, {Michael R.} and Solomon, {Scott D.} and Milton Packer and McMurray, {John J.V.} and {PARADIGM-HF Investigators and Committees}",

year = "2017",

month = jun,

doi = "10.1016/j.ahj.2017.02.034",

language = "English",

volume = "188",

pages = "35--41",

journal = "American Heart Journal",

issn = "0002-8703",

publisher = "Mosby Inc.",

}

TY - JOUR

T1 - The effects of sacubitril/valsartan on coronary outcomes in PARADIGM-HF

AU - Mogensen, Ulrik M.

AU - Køber, Lars

AU - Kristensen, Søren L.

AU - Jhund, Pardeep S.

AU - Gong, Jianjian

AU - Lefkowitz, Martin P.

AU - Rizkala, Adel R.

AU - Rouleau, Jean L.

AU - Shi, Victor C.

AU - Swedberg, Karl

AU - Zile, Michael R.

AU - Solomon, Scott D.

AU - Packer, Milton

AU - McMurray, John J.V.

AU - PARADIGM-HF Investigators and Committees

PY - 2017/6

Y1 - 2017/6

N2 - Background Angiotensin converting enzyme inhibitors (ACE-I), are beneficial both in heart failure with reduced ejection fraction (HF-REF) and after myocardial infarction (MI). We examined the effects of the angiotensin-receptor neprilysin inhibitor sacubitril/valsartan, compared with the ACE-I enalapril, on coronary outcomes in PARADIGM-HF. Methods and results We examined the effect of sacubitril/valsartan compared with enalapril on the following outcomes: i) the primary composite endpoint of cardiovascular (CV) death or HF hospitalization, ii) a pre-defined broader composite including, in addition, MI, stroke, and resuscitated sudden death, and iii) a post hoc coronary composite of CV-death, non-fatal MI, angina hospitalization or coronary revascularization. At baseline, of 8399 patients, 3634 (43.3%) had a prior MI and 4796 (57.1%) had a history of any coronary artery disease. Among all patients, compared with enalapril, sacubitril/valsartan reduced the risk of the primary outcome (HR 0.80 [0.73–0.87], P < .001), the broader composite (HR 0.83 [0.76–0.90], P < .001) and the coronary composite (HR 0.83 [0.75–0.92], P < .001). Although each of the components of the coronary composite occurred less frequently in the sacubitril/valsartan group, compared with the enalapril group, only CV death was reduced significantly. Conclusions Compared with enalapril, sacubitril/valsartan reduced the risk of both the primary endpoint and a coronary composite outcome in PARADIGM-HF. Additional studies on the effect of sacubitril/valsartan on atherothrombotic outcomes in high-risk patients are merited.

AB - Background Angiotensin converting enzyme inhibitors (ACE-I), are beneficial both in heart failure with reduced ejection fraction (HF-REF) and after myocardial infarction (MI). We examined the effects of the angiotensin-receptor neprilysin inhibitor sacubitril/valsartan, compared with the ACE-I enalapril, on coronary outcomes in PARADIGM-HF. Methods and results We examined the effect of sacubitril/valsartan compared with enalapril on the following outcomes: i) the primary composite endpoint of cardiovascular (CV) death or HF hospitalization, ii) a pre-defined broader composite including, in addition, MI, stroke, and resuscitated sudden death, and iii) a post hoc coronary composite of CV-death, non-fatal MI, angina hospitalization or coronary revascularization. At baseline, of 8399 patients, 3634 (43.3%) had a prior MI and 4796 (57.1%) had a history of any coronary artery disease. Among all patients, compared with enalapril, sacubitril/valsartan reduced the risk of the primary outcome (HR 0.80 [0.73–0.87], P < .001), the broader composite (HR 0.83 [0.76–0.90], P < .001) and the coronary composite (HR 0.83 [0.75–0.92], P < .001). Although each of the components of the coronary composite occurred less frequently in the sacubitril/valsartan group, compared with the enalapril group, only CV death was reduced significantly. Conclusions Compared with enalapril, sacubitril/valsartan reduced the risk of both the primary endpoint and a coronary composite outcome in PARADIGM-HF. Additional studies on the effect of sacubitril/valsartan on atherothrombotic outcomes in high-risk patients are merited.

U2 - 10.1016/j.ahj.2017.02.034

DO - 10.1016/j.ahj.2017.02.034

M3 - Journal article

C2 - 28577679

AN - SCOPUS:85016075621

SN - 0002-8703

VL - 188

SP - 35

EP - 41

JO - American Heart Journal

JF - American Heart Journal

ER -

The effects of sacubitril/valsartan on coronary outcomes in PARADIGM-HF

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