A breakthrough in heart failure treatment?

This study compared the long-term effects of LCZ696 on morbidity (having a disease condition) and mortality (death) to those of enalapril in patients with chronic heart failure.

Heart failure is a condition in which the heart is unable to pump enough blood through to meet the body's needs for blood and oxygen. The leading causes for this condition are high blood pressure (hypertension) coronary artery disease (disease in the arteries that supply blood to the heart) and diabetes. Therefore, one of the major goals in heart failure treatment is treating its underlying causes.

Enalapril, an angiotensin-converting–enzyme (ACE) inhibitor has been the cornerstone of the treatment for heart failure for nearly 25 years. ACE is a major enzyme in the renin angiotensin system (RAS), an important system responsible for elevating blood pressure in the body. Once ACE is inhibited by enalapril blood pressure is lowered, allowing the heart to pump more blood to the body against reduced pressure.

LCZ696 is a new drug under investigation. It is composed of 2 antihypertensive drugs with different modes of action compared to ACE inhibitors. It inhibits neprilysin (an enzyme that constricts blood vessels therefore increases blood pressure) and blocks angiotensine2 (another enzyme in the RAS system) from binding to its receptor.

This study examined the long term effects of LCZ696 in patients with symptomatic heart failure compared with the effects of enalapril.

This study enrolled 8,442 patients. All patients were over 18 years of age, suffered symptomatic heart failure and had a reduced percentage of blood ejected from their heart during each heartbeat (reduced ejection fraction). 4,187 patients were randomly assigned to receive LCZ696 (average dose of 375 mg) and 4,212 to receive enalapril (average dose of 18.9 mg). During an average follow up period of 27 months researchers recorded any report of death from cardiovascular cause or a first hospitalization for heart failure.

Following analysis researchers concluded that the inhibition of both the angiotensin II receptor and neprilysin with LCZ696 was more effective in reducing the risk of death from cardiovascular causes or hospitalization for heart failure than was ACE inhibition with enalapril. 13.3% of those taking LCZ696 died from cardiovascular causes compared to 16.5% of those taking enalapril. The LCZ696 group showed a 20% decrease in risk of death from cardiovascular causes when compared with the enalapril group. Furthermore, when compared with enalapril, LCZ696 also reduced the risk of hospitalization for heart failure by 21%.

It is important to underline that in this study LCZ696 was not accompanied with important safety concerns when compared with enalapril. Because of its greater vasodilator effects (widening of blood vessels due to smooth muscle cell relaxation), treatment with LCZ696 was associated with a higher rate of symptomatic hypotension  (low blood pressure) and angioedema (swelling of the skin due to accumulation of excess water in the tissue) although neither conditions led to serious adverse effects.

This study concluded that LCZ696 is superior to enalapril in reducing the risks of death and of hospitalization for heart failure.

None of the medications listed above should be taken without consulting with your doctor as all have adverse effects. Furthermore, medical treatment isn’t the only treatment for heart failure and it should be combined with healthy lifestyle changes (such as a healthy diet, weight reduction, quitting smoking and a precise amount of fluid intake).