美国维利西呱能治好心力衰竭吗？

Vericiguat does not cure heart failure, but it reduces the risk of cardiovascular death and heart failure hospitalization in adults with symptomatic heart failure and reduced ejection fraction.

Treat heart failure

Vericiguat is a soluble guanylyl cyclase agonist that acts on the nitric oxide-soluble guanylyl cyclase-cyclic guanosine monophosphate pathway. It not only enhances the sensitivity of soluble guanylyl cyclase to nitric oxide, but also directly stimulates soluble guanylyl cyclase independently of nitric oxide, increasing the production of cyclic guanylyl cyclase and exerting multi-dimensional protective effects on the heart. It provides a new treatment approach for patients with heart failure.

Vericiguat’s mechanism of action

Chronic heart failure is the terminal manifestation and main cause of death of various cardiovascular diseases. In addition to classic neuroendocrine blocking drugs, there are also drugs that intervene on other targets. The nitric oxide (NO)-soluble guanylate cyclase (sGC)-cyclic guanosine monophosphate (cGMP) pathway plays an important role in the regulation of cardiovascular function and is disrupted in heart failure (HF), resulting in decreased protection against myocardial injury.

Impaired NO-sGC-cgmp signaling in HF is secondary to reduced NO bioavailability and altered sGC redox status, resulting in reduced sGC reactivity to NO. The sGC activator cinaciguat increases cGMP levels through NO-independent direct activation of sGC and may be particularly effective in situations of increased oxidative stress and endothelial dysfunction, thereby reducing NO levels, but at the expense of a greater risk of hypotension.

On the contrary, the sGC stimulator (veliciguat) can enhance the sensitivity of sGC to endogenous NO, thereby exerting a greater physiological effect. The soluble guanylate cyclase agonist vericiguat can treat chronic heart failure by acting on the nitric oxide-soluble guanylate cyclase-cyclic guanylate pathway.

Clinical trials suggest that vericiguat is associated with lower rates of death, particularly from cardiovascular causes or hospitalization for heart failure. The addition of vericiguat may be considered in patients with heart failure and reduced left ventricular ejection fraction (HFrEF), especially those who are at increased risk of hospitalization for heart failure.

References

Lombardi CM, Cimino G, Pagnesi M, Dell'Aquila

A, Tomasoni D, Ravera A, Inciardi R, Carubelli V, Vizzardi E, Nodari S,

Emdin M, Aimo A. Vericiguat for Heart Failure with Reduced Ejection

Fraction. Curr Cardiol Rep. 2021 Aug 19;23(10):144. doi:

10.1007/s11886-021-01580-6. PMID: 34410527; PMCID: PMC8376697.