A PARADIGM Shift in Heart-Failure Treatment?

Heart failure (HF) afflicts millions, and associated morbidity and mortality remain high despite our extensive current treatment armamentarium. Thus, the search for new weapons goes on. Recently, attention has focused on offsetting the neurohormonal overactivation that accompanies HF by inhibiting neprilysin, a neutral endopeptidase that degrades endogenous natriuretic peptides.

In the industry-supported, randomized, PARADIGM-HF trial (NCT01035255), investigators compared LCZ696 — an experimental compound containing sacubitril, a neprilysin inhibitor, and valsartan, an angiotensin-receptor blocker — with enalapril in 8399 adults (average age, 64) with symptomatic HF (New York Heart Association class II–IV) and left ventricular ejection fract…