European Journal of Biomedical and Pharmaceutical Sciences

SACUBITRIL/VALSARTAN VERSUS ENALAPRIL IN ISCHEMIC AND NONISCHEMIC HEART FAILURE (PARADIGM-HF SUBGROUP ANALYSIS)

*Mohammed Habib, MD, PhD

ABSTRACT

Background: We compared the angiotensin receptor–neprilysin inhibitor (LCZ696 or sacubitril/valsartan) with enalapril in patients who had ischemic and nonischemic heart failure with a reduced ejection fraction. Methods: In this double-blind trial, we randomly assigned 8442 patients with class II, III, or IV heart failure and an ejection fraction of 40% or less to receive either LCZ696 (at a dose of 200 mg twice daily) or enalapril (at a dose of 10 mg twice daily), in addition to recommended therapy. The primary outcome was a composite of death from cardiovascular causes or hospitalization for heart failure, but the trial was designed to detect a difference in the rates of death from cardiovascular causes. Results: The trial was stopped early, after a median follow up of 27 months, because the boundary for an overwhelming benefit with LCZ696 had been crossed. The ischemic patients were 5036 (60%) patients and non-ischemic patients were 3363 (40%) patients. In ischemic and in nonischemic group the LCZ696 was superior to enalapril for reduce primary outcome and cardiovascular death (CV) death (P< 0.001). In LCZ696 group: the primary outcome had occurred in 339 patients (20.16 %) in the non-ischemic group and 575 patients (22.9 %) in the ischemic group (P: 0.03). A total of 199 patients (11.8%) in non-ischemic group and 359 patients in ischemic group (14.3%) died from cardiovascular causes (P: 0.01). in patient who receive enalapril no significant difference between CV death and primary outcome in the ischemic and nonischemic patients. Conclusions: LCZ696 was superior to enalapril in reducing the risks of cardiovascular death and hospitalization for heart failure in ischemic and nonischemic heart failure. LCZ696 also was superior to reducing the risks of cardiovascular death and hospitalization for heart failure in nonischemic than ischemic heart failure.

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