Efficacy and safety of sacubitril/valsartan on heart failure with preserved ejection fraction: A meta-analysis of randomized controlled trials

Wanqian Yu; Hongzhou Zhang; Wen Shen; Fan Luo; Shuai Yang; Lujin Gan; Yuanbin Zhao; Pingping Yang; Qinghua Wu

doi:10.3389/fcvm.2022.897423

Efficacy and safety of sacubitril/valsartan on heart failure with preserved ejection fraction: A meta-analysis of randomized controlled trials

Front Cardiovasc Med. 2022 Sep 8:9:897423. doi: 10.3389/fcvm.2022.897423. eCollection 2022.

Authors

Wanqian Yu¹, Hongzhou Zhang¹, Wen Shen¹, Fan Luo², Shuai Yang¹, Lujin Gan¹, Yuanbin Zhao¹, Pingping Yang³, Qinghua Wu¹

Affiliations

¹ Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
² Medical Center of the Graduate School, Nanchang University, Nanchang, China.
³ Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, China.

Abstract

Aims: The efficacy and safety of sacubitril/valsartan for patients with heart failure with preserved ejection fraction (HFpEF) are controversial. Hence, the primary objective of the study was to evaluate the efficacy and safety of sacubitril/valsartan treatment for patients with HFpEF.

Methods and results: We used the PubMed, Embase, and Web of Science databases to search for randomized controlled trials of sacubitril-valsartan in patients with HFpEF. Three studies, involving a total of 7,663 patients, were eligible for inclusion. Sacubitril-valsartan reduced the risk of hospitalization for heart failure (HF) [odds ratio (OR): 0.78; 95% CI: 0.70-0.88; p < 0.0001] and the incidence of worsening renal function [risk ratio (RR): 0.79, p = 0.002] among patients with HFpEF in the three trials, but there was no significant reduction in all-cause mortality (0.99, 95% CI: 0.84-1.15; p = 0.86) or cardiovascular mortality (0.95, 95% CI: 0.78-1.15; p = 0.16). Moreover, sacubitril/valsartan was associated with an increased risk of symptomatic hypotension (RR: 1.44; p < 0.00001) and angioedema (RR: 2.66; p < 0.04); there was no difference for decreasing the incidence of hyperkalemia (RR: 0.89; p = 0.11).

Conclusion: Compared with valsartan or individualized medical therapy (IMT), sacubitril/valsartan significantly decreased the risk of hospitalization for HF and reduced the incidence of renal dysfunction.

Keywords: LCZ696; heart failure; heart failure with preserved ejection fraction (HFpEF); meta-analysis; sacubitril/valsartan.