Oral Soluble Guanylate Cyclase Stimulators Well-Tolerated in Heart Failure

Computer illustration of a heart.
Cardiopulmonary adverse events with carfilozmib treatment included dyspnea, hypertension, peripheral edema, cough, pneumonia, and heart failure.
Oral sGC stimulators are very beneficial for patients with HF: They are well-tolerated and reduce the incidence of HF hospitalization; however, they do not reduce cardiovascular deaths among patients with HFrEF, and there are no apparent benefits in HFpEF.

The following article is a part of conference coverage from the American College of Cardiology’s 70th Annual Scientific Session & Expo is being held virtually from May 15 to 17, 2021. The team at Cardiology Advisor will be reporting on the latest news and research conducted by clinicians and scientists in the field. Check back for more from the ACC 2021 .

Oral soluble guanylate cyclase (sGC) stimulators are well-tolerated in people with heart failure (HF) and reduce cardiovascular deaths among persons with heart failure with reduced ejection fraction (HFrEF). This is according to research presented at the American College of Cardiology 2021 Annual Meeting, held May 15-17, 2021 and published in a supplemental issue of the Journal of the American College of Cardiology.

Because oral sGC stimulators are a novel medication class, researchers conducted a systematic review and meta-analysis to evaluate the safety and efficacy of these medications for HFrEF or heart failure with preserved ejection fraction (HFpEF).

The review comprised 7 randomized controlled trials: 3 including patients with HFrEF and 4 including patients with HFpEF, with a follow-up period ranging from 1 month to a median of 10.8 months.

The total patient population included 7190 patients (HFrEF: n=5707; HFpEF: n=1483). Among patients with HFrEF, oral sGC stimulators demonstrated a reduced incidence of composite HF hospitalization and cardiovascular death (hazard ratio [HR] 0.87 [95% CI, 0.78-0.97]; I2=0), driven, per the researchers, by lower hospitalization for HF (HR 0.88 [95% CI, 0.78-0.99]; I2=0).

The investigators noted no significant difference in all-cause death in either cohort of patients (HFrEF: HR 0.95 [95% CI, 0.83-1.09]; I2=0 and HFpEF: HR 1.94 [95% CI, 0.92-4.09]; I2=0).

Among patients with HFpEF, the researchers noted no improvements in Kansas City Cardiomyopathy Questionnaire clinical summary scores (mean difference 0.81 [95% CI, -2.16 to 3.77]; I2 =72%) or in 6-minute walk distance (mean difference 3.34 m [95% CI, -7.86 to 14.54]; I2=28%).

The researchers noted low rates of medical-related serious adverse events.

“Oral sGC stimulators are well tolerated in HF and reduce the incidence of HF hospitalization but not cardiovascular deaths among patients with HFrEF,” the researchers concluded. “However, there are no apparent benefits in HFpEF.”

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Moghaddam N, Malhi N, Toma M. Impact of oral soluble guanylate cyclase stimulators in patients with heart failure: a systematic review and meta-analysis of randomized controlled trials. Presented at: American College of Cardiology (ACC) 2021 Annual Meeting; May 15-17, 2021. Abstract.