The primary endpoint was statistically significant–10% relative risk reduction, but it was a very short follow up of about 10 months on average because these patients had such a high risk–about 3 times a higher risk than some of the recent heart failure trials that we have seen. If you actually look at the absolute risk reduction, there was about a 4% absolute risk reduction, which is the same or better than some of the recent trials that we’ve seen, said Javed Butler, MD, MPH, MBA, professor of physiology and chairman for the Department of Medicine at the University of Mississippi.
There are about 6 million people in the us that have heart failure the annual incidence is about three-quarters of a million or a little bit higher than that so the burden is quite extensive and unfortunately they’re beginner logic trends are such that this this will increase by about 25 percent by the year 2030 so not only is a burden quite high right now it
Is expected to go up pretty substantially as well but there are some groups of people who are at a particularly higher risk for developing heart failure so those people who have diabetes obesity high blood pressure albula heart disease so these are the people that have a higher risk of developing heart failure but i think probably the biggest reason why the
The incidence and the prevalence of heart failure is increasing is because of the ageing of the population is those heart failure cases are in older patients older patients are at a higher risk yes sir heart failure is a state in which you have generalized endothelial dysfunction and decreased nitric oxide production actually nitric oxide is the molecule that
Goes into the cell and then binds to this enzyme called soluble gold and late cyclase and after binding that that in leads to increased production and off cycle jpso cyclic gmp signaling further down in multiple organs of the body and a lot of beneficial effects but in terms of cardiovascular system you know it causes vasodilation improve endothelial function
Decrease fibrosis of the heart remodeling of the heart so there are all these beneficial effects then occur in the cardiovascular system but in the presence of oxidative stress there is substantial reduction in nitric oxide and subsequently the action of the smaller culinary extract links so what maurice lacroix does it’s a novel medication that sort of bypasses
That nitric oxide step and just directly bind and stimulate the soluble guanylate cyclase directly increasing the sol cgmp production and all the downstream beneficial effect on the cardiovascular system so there is certainly an unmet need in patients with heart failure reduce ejection fraction if you look at over the past three decades or so there’s been a lot
Of good medications that have come out to show benefit and outcomes for these patients but remember we started at such a bad point you know people had 30 35 percent one-year mortality there even with all those therapies the reduction in mortality you know even in the stable patients we’re talking about 10% or so annual mortality now there’s a special high risk
Group of patients called the worst thing heart failure these are the patients who have been stable sort of in the outpatient setting on whatever the medication that you were giving them but now that turkey is not enough for them and now they’re developing worsening heart failure symptoms requiring escalation of therapy or hospitalization in many many cases and
This is patients once they get hospitalized we are talking about 25 to 30 percent money in mortality so much higher risk group of patients so that’s where this medication very seaguar was tested in the victoria trial and what he found was at the primary endpoint for combined arterial hospitalization and cardiovascular mortality was benefit was beneficial now you
Know what is the magnitude of benefit it has to be sort of looked at in both a relative risk reduction and absolute risk reduction because the amount of benefit is actually related not only to how efficacious the drug is went as well as what is the base my patient population which was admitted in the clinical trial what would the inclusion/exclusion criteria so
As mentioned this was a high-risk group of patient the primary endpoint was statistically significant there was a 10% relative risk reduction but it was a very short follow-up of about 10 months on average because these patients had such a high risk about three times the higher risk than some of the recent heart failure trials that we have seen so therefore the
Event accumulation was much faster and as i said the average hope was about 10 months or so so if you actually look at the absolute risk reduction and there was about a four absolute risk reduction which is the same or better than some of the recent trials that we have seen
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Dr Javed Butler on Key Takeaways of Vericiguat Found in VICTORIA Trial Participants With HFrEF By AJMCtv
