Sacubitril/Valsartan vs ACE Inhibitors or ARBs
Year: 2025
Type: article
Study designs: Systematic Review, Meta-Analysis
Abstract: BACKGROUND: Sacubitril/valsartan (SAV) is crucial for managing heart failure (HF). Randomized clinical trials have shown SAV's superiority over angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARBs) in reducing N-terminal pro-B-type natriuretic peptide levels. However, results for cardiovascular (CV) mortality, HF rehospitalization, and all-cause mortality have been mixed. OBJECTIVES: This study aimed to determine hard endpoints among the population with HF treated with SAV vs ACEI/ARBs and conduct a comprehensive risk-benefit analysis of the safety profile for SAV vs ACEI/ARB. METHODS: test was used to assess between-study heterogeneity. Publication bias was assessed via funnel plots and the Egger test. This study was registered in PROSPERO (CRD42024497661). RESULTS: The study included a total of 14 trials (n = 25,167). SAV reduced all-cause mortality in the population with an ejection fraction (EF) ≤40% (RR: 0.88; 95% CI: 0.81-0.94; P = 0.0006), but not in those with EF >40% (RR: 0.97; 95% 0.85-1.11; P = 0.67). There was no difference in CV mortality across EF spectrums (RR: 0.9; 95% CI: 0.79-1.03; P = 0.13). HF readmission was lower in the SAV-treated group regardless of EF (RR: 0.85; 95% CI: 0.79-0.91; P = 0.00001). CONCLUSIONS: The SAV-treated group, across all EF spectrum, was less likely to be rehospitalized than the ACEI/ARB-treated group. However, all-cause mortality reduction was only noted in the SAV group with EF <40%. No reduction in CV-related mortality was observed across the EF spectrum.
Source: JACC Advances
Institution: Jefferson Einstein Philadelphia Hospital
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,936
OpenAlex ID: W4407697646