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Sacubitril/Valsartan vs ACE Inhibitors or ARBs: A Systematic Review and Meta-Analysis of Randomized Trials
Endurance Evbayekha1, Abiodun Benjamin Idowu2, Shane LaRue1
1St. Luke's Hospital, Chesterfield, Missouri, USA.
JACC. Advances
|February 19, 2025
Summary
Sacubitril/valsartan (SAV) reduces heart failure rehospitalizations across ejection fractions (EF). However, it only lowers all-cause mortality in patients with EF ≤40%, with no significant impact on cardiovascular mortality.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Sacubitril/valsartan (SAV) is a key treatment for heart failure (HF).
- Previous trials indicated SAV's superiority over ACEI/ARBs in reducing NT-proBNP.
- Mixed results exist regarding SAV's impact on hard clinical endpoints like mortality and rehospitalization.
Purpose of the Study:
- To evaluate hard endpoints in HF patients treated with SAV versus ACEI/ARBs.
- To conduct a comprehensive risk-benefit analysis of SAV compared to ACEI/ARB.
Main Methods:
- Systematic review and meta-analysis of randomized clinical trials (RCTs) up to November 2023.
- Included 14 RCTs with 25,167 participants comparing SAV to ACEI or ARBs.
- Analyzed all-cause mortality, CV mortality, and HF rehospitalizations using random-effects models and risk ratios.
Main Results:
- SAV significantly reduced HF rehospitalizations across all ejection fraction (EF) levels (RR: 0.85).
- All-cause mortality was reduced with SAV in patients with EF ≤40% (RR: 0.88), but not in those with EF >40% (RR: 0.97).
- No significant difference in cardiovascular mortality was observed between SAV and ACEI/ARB groups (RR: 0.9).
Conclusions:
- SAV demonstrates a significant benefit in reducing HF rehospitalizations irrespective of EF.
- The reduction in all-cause mortality with SAV is confined to patients with reduced EF (≤40%).
- SAV does not show a significant advantage over ACEI/ARBs in reducing cardiovascular mortality.
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