Sacubitrilo-valsartán e inhibidores del cotransportador de sodio-glucosa tipo 2 en insuficiencia cardiaca: ¿separación de poderes o bienes gananciales? / Sacubitril-valsartan and sodium-glucose linked transporter-2 inhibition in heart failure: give separately or together?

La coexistencia de insuficiencia cardiaca (IC) con fracción de eyección del ventrículo izquierdo (FEVI) reducida y diabetes es muy frecuente. En los últimos años, el sacubitrilo-valsartán (SV) y la familia de los inhibidores del cotransportador de sodio-glucosa tipo 2 (iSGLT2) han pasado a formar parte del arsenal terapéutico habitual del profesional dedicado a la IC. Comparado con el enalapril, se ha demostrado con el SV en pacientes con IC y FEVI reducida una clara mejoría a nivel pronóstico y de calidad de vida; la familia de fármacos glucosúricos ha mostrado beneficios significativos en protección renal y hospitalización por IC en una población más variada, donde la prevalencia de IC basal es baja. Se revisa la evidencia actual de los 2 fármacos y el uso combinado de ambos. Información sobre el suplemento: este artículo forma parte del suplemento titulado «Controversias para una nueva era en el tratamiento de la insuficiencia cardiaca», que ha sido patrocinado por Novartis

Heart failure with a reduced left ventricular ejection fraction (HFrEF) commonly coexists with diabetes. In recent years, sacubitril-valsartan and the family of sodium-glucose cotransporter-2 (SGLT2) inhibitors have become established as part of the routine therapeutic armamentarium for clinicians dealing with heart failure. In patients with HFrEF, sacubitril-valsartan has been associated with a substantially better prognosis and quality of life compared with enalapril. In addition, the family of SGLT2 inhibitors have demonstrated significant clinical benefits in a more varied patient population with a low prevalence of heart failure at baseline: they preserved renal function and reduced hospitalization for heart failure. The aim of this article was to review the evidence currently available on these two drugs classes and on their use in combination. Supplement information: this article is part of a supplement entitled "Questions on a new era for heart failure treatment" which is sponsored by Novartis

Evolution of functional class, biochemical and echocardiographic parameters and clinical outcomes after sacubitril/valsartan initiation in daily practice.

Aim: To analyze the impact of sacubitril/valsartan on functional class, surrogate parameters and clinical outcomes in clinical practice. Methods: Retrospective study of patients with heart failure and reduced ejection fraction that started treatment with sacubitril/valsartan. Results: 149 patients (70.7 ± 9.6 years) were included. At baseline, 83.9, 15.4 and 0.7% were taking sacubitril/valsartan 24/26, 49/51 and 97/103 mg, respectively. After 316.1 ± 155.9 days, these numbers moved to 38.9, 39.6, 12.8% (8.7% discontinued). Sacubitril/valsartan improved functional class (from 2.3 ± 0.6 to 1.8 ± 0.5; p < 0.001), increased ejection fraction (from 31.2 ± 7.0 to 37.3 ± 10.5%; p < 0.001) and reduced NT-proBNP (from 3884 ± 4871 to 1975.3 ± 3006.6 pg/ml; p = 0.0001). Rates of any event, cardiovascular death and heart failure hospitalization/decompensation were 13.2 events/100 patient-years. Conclusion: Sacubitril/valsartan is effective and safe in routine practice.