维利西呱片的功效与作用

Vericiguat reduces the risk of cardiovascular death and hospitalization for heart failure (HF) or the need for emergency intravenous diuretic therapy by less than 45% in adults with symptomatic chronic heart failure. Vericiguat can directly stimulate SGC and increase the production of cyclic guanosine monophosphate without relying on endogenous nitric oxide. Vericiguat can improve myocardial and vascular function, restore the weakened myocardium to strong blood-pumping ability, and achieve the effect of improving heart failure by dilating systemic and pulmonary blood vessels and reducing heart beating resistance. Vericiguat is a new oral, soluble guanylate cyclase (sGC) agonist that was approved for marketing by the US FDA on January 19, 2021.

In a phase 3 randomized, double-blind, placebo-controlled trial (NCT02861534), 5050 patients with chronic heart failure (New York Heart Association class II, III, or IV) with an ejection fraction less than 45% were divided into two groups: one group received veliciguat (target dose, 10 mg daily) or placebo, and the other group received guideline-based medical treatment. The primary outcome was a composite of death from cardiovascular causes or first hospitalization for heart failure.

Results: Over an average of 10.8 months, primary outcome events occurred in 897 of 2526 patients (35.5%) in the validation group and 972 of 2524 patients (38.5%) in the placebo group. There were 414 patients (16.4%) in the placebo group and 441 patients (17.5%) in the placebo group. Symptomatic hypotension occurred in 9.1% of patients in the veliciguat group and 7.9% of patients in the placebo group (P=0.012), and syncope occurred in 4.0% of patients in the veliciguat group and 3.5% of patients in the placebo group (P=0.030).

Conclusions: Among patients with high-risk heart failure, those taking veliciguat had a lower incidence of death from cardiovascular causes or hospitalization for heart failure than those taking placebo.

Veliciguat can not only increase the sensitivity of sGC to endogenous NO, but also directly stimulate sGC to increase the formation of cGMP, that is, it has a dual mode of action. By increasing intracellular cGMP levels, a multi-dimensional protective effect is produced. It is recommended that patients take medication under the guidance of a doctor and receive symptomatic treatment.

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References

Armstrong PW, Pieske B, Anstrom KJ, Ezekowitz J, Hernandez AF, Butler J, Lam CSP, Ponikowski P, Voors AA, Jia G, McNulty SE, Patel MJ, Roessig L, Koglin J, O'Connor CM; VICTORIA Study Group. Vericiguat in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2020 May 14;382(20):1883-1893. doi: 10.1056/NEJMoa1915928. Epub 2020 Mar 28. PMID: 32222134.