Could you describe the main advances in chronic HF pharmacology?
Yes, I would say that we have now two main groups of new drugs. The first one is an old intervention that has changed its name from “anti-aldosteronic” (agents) to “mineralocorticoid receptor antagonists”.
This group has shown solid evidence in preventing heart failure mortality, heart failure hospitalization, etc.
The other group is the really new one, which is already on the market, which they call ARNI – angiotensin receptor neprilysin inhibitors – which (represents) a dual inhibition of the renin-angiotensin-aldosterone system.
And the trademark is the real advance in improving the outcomes, mainly mortality and heart failure hospitalization in patients with chronic heart failure.
How do these advances translate into clinical practice?
I could say that most cardiologists around the world have been using ACE inhibitors and angiotensin antagonists in the past 30 years or so. Now we have to change our mind to this new class of intervention, because the scientific evidence showed by results of clinical trials by these two groups of drugs has a real impact on clinical practice.
So that is the real issue to reconsider. Cardiologists might take into account these new drugs, which are really, really improving the prognosis of chronic heart failure.
What are the new drugs in the pipeline we should look out for?
I would say that there are many. I would point out one group which is called the SGLT-2 inhibitors that surprisingly have been produced as anti-diabetic drugs, but an initial trial has demonstrated a clear benefit in improving the cardiovascular outcomes – mainly mortality, heart failure hospitalization, myocardial infarction, etc. Now do to this striking result most of the sponsors are planning new mega-trials using this drug only in patients with heart failure.
So the million-dollar question is, are they going to demonstrate a great benefit in heart failure despite the patients being diabetic or not – we don’t know yet.
And we’re going to have the answer in a couple more of years.