Key result
Vericiguat yields an absolute ~4-point reduction in CV death or HF hospitalization in HFrEF.
Why the study?
To describe the chemical and mechanistic aspects, pharmacokinetics, adverse effects, and contraindications of vericiguat to facilitate its optimal therapeutic use.
Does oral vericiguat reduce the risk of cardiovascular death or heart failure hospitalization in adults with symptomatic chronic heart failure and LVEF <45% following a worsening heart failure event?
Does oral vericiguat reduce the risk of cardiovascular death or heart failure hospitalization in adults with symptomatic chronic heart failure and LVEF <45% following a worsening heart failure event?
This pharmacology and clinical review summarizes the mechanism, pharmacokinetics, and pivotal trial evidence supporting vericiguat as an FDA-approved soluble guanylate cyclase stimulator for reducing cardiovascular death and heart failure hospitalization in patients with worsening HFrEF (LVEF <45%).
Answers are grounded in this paper and cite their sources.
May support vericiguat addition in worsening HFrEF; leaves open optimal sequencing and long-term outcomes.
Heart failure with reduced ejection fraction (HFrEF) is the inability of the heart to adequately contract or eject blood. This heart is unable to produce adequate cardiac output to perfuse vital tissues. At a fundamental level, it is known that the cardioprotective pathway of nitric oxide-soluble guanylate cyclase-cyclic guanosine monophosphate is impaired in heart failure patients. Vericiguat is a novel, orally used, small molecule, and direct stimulator of the soluble guanylate cyclase, and thus, it enhances the production of cyclic guanosine monophosphate. Vericiguat was approved by the FDA in January of 2021 to reduce the risk of cardiovascular death and heart failure hospitalization following a hospitalization for heart failure or need for outpatient IV diuretics, in adults with symptomatic chronic heart failure and ejection fraction less than 45%. In this review, we describe the chemical and mechanistic aspects, pharmacokinetics, adverse effects, and contraindications of vericiguat so as to facilitate its optimal therapeutic use.
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Chiles et al. (2022) conducted a review in Heart failure with reduced ejection fraction (HFrEF) and symptomatic chronic heart failure with LVEF <45%. Vericiguat vs. Placebo was evaluated on Composite of cardiovascular death or heart failure hospitalization (ARR 4.2% (annualized, in VICTORIA trial)). Vericiguat achieved an annualized absolute risk reduction of 4.2% compared with placebo for cardiovascular death or heart failure hospitalization in adults with chronic heart failure and LVEF <45%.
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