From ACE Inhibitors/ARBs to ARNIs in Coronary Artery Disease and Heart Failure (Part 2/5)

Darryl P Leong; John J V McMurray; Philip G Joseph; Salim Yusuf

doi:10.1016/j.jacc.2019.04.068

From ACE Inhibitors/ARBs to ARNIs in Coronary Artery Disease and Heart Failure (Part 2/5)

J Am Coll Cardiol. 2019 Aug 6;74(5):683-698. doi: 10.1016/j.jacc.2019.04.068.

Authors

Darryl P Leong¹, John J V McMurray², Philip G Joseph³, Salim Yusuf³

Affiliations

¹ The Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada. Electronic address: Darryl.Leong@phri.ca.
² British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
³ The Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.

PMID: 31370961
DOI: 10.1016/j.jacc.2019.04.068

Abstract

The pharmacological inhibition of the renin-angiotensin-aldosterone system as a therapeutic strategy is one of the most significant advances in the treatment and prevention of cardiovascular disease in heart failure with reduced ejection fraction and in coronary artery disease. Recently, the addition of neprilysin inhibition to angiotensin receptor blockade has been shown to be even more effective than angiotensin-converting enzyme inhibition alone in heart failure with reduced ejection fraction, marking an important new milestone in heart failure treatment. This review summarizes the major trials that have informed the clinical role of inhibition of the renin-angiotensin-aldosterone and neprilysin pathways, as well as the limitations of these strategies.

Keywords: ACE-I; ARB; ARNI; coronary disease; heart failure.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Angiotensin Receptor Antagonists / therapeutic use*
Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
Coronary Artery Disease / drug therapy*
Coronary Artery Disease / physiopathology
Drug Therapy, Combination
Heart Failure / drug therapy*
Heart Failure / physiopathology
Humans
Renin-Angiotensin System / drug effects*
Stroke Volume / physiology*

Substances

Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors