The following is a summary of “Age Differences in Effects of Sacubitril/Valsartan on Cardiac Remodeling, Biomarkers, and Health Status” published in the December 2022 issue of Heart Failure by Murphy et al.
In individuals with heart failure and a low ejection fraction(HFrEF), sacubitril/valsartan (Sac/Val) improves survival. They hoped to find out if Sac/Val affected biomarkers, Kansas City Cardiomyopathy Questionnaire(KCCQ)-23 scores, and cardiac remodeling differently depending on patient age. N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hs-cTnT), and soluble suppressor of tumorigenicity 2 (sST2) concentrations and KCCQ-23 scores were assessed from baseline to 12 months after beginning and titration of Sac/Val. The echocardiographic measurements included the left ventricular ejection fraction (LVEF), left ventricular end-systolic volume index (LVESVi), left ventricular end-diastolic volume index (LVEDVi), and left atrial volume index (LAVi). Indicators of safety were evaluated.
It was divided into subgroups of people aged less than 65 and up, those aged 65-74, and those aged ≥75 and up. Similar decreases in hs-cTnT and sST2 were seen in patients more than 65 years (n=369), 65-74 years (n=237), and those ≥75 years (n=188); P=0.02), whileN-terminal pro–B-type natriuretic peptide(NT-proBNP) reduction was reduced in patients ≥75 years of age (n=188). Although similar proportions of patients in each age group achieved ≥10-point and ≥20-point gains in KCCQ-23 by month 12, gains in patients over (≥ 75 years) were less (+11.8 vs +11.4 vs. +6.0 points; P=0.03).
There was no significant difference in the rate of improvement of LVEF, LVEDVi, LVESVi, or LAVi between the younger and older patients. Similarly, comparable rates of occurrence were seen for safety endpoints. From baseline through month 12, Sac/Val significantly enhanced prognostic biomarkers and measures of cardiac remodeling and health status across all age groups. Both the decrease in NT-proBNP and the increase in KCCQ-23 overall summary scores were attenuated slightly in the elderly participants of the research. (The Sacubitril/Valsartan Effects on Biomarkers, Myocardial Remodeling, and Outcomes [PROVE-HF]; NCT02887183)