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World J Cardiol. Jul 26, 2017; 9(7): 594-599
Published online Jul 26, 2017. doi: 10.4330/wjc.v9.i7.594
Is Entresto good for the brain?
Nirav Patel, Jason Gluck
Nirav Patel, Jason Gluck, Department of Cardiology, University of Connecticut, Harford Hospital, Hartford, CT 06102, United States
Author contributions: Patel N made substantial contributions to conception and design and writing the manuscript; Gluck J participated drafting the manuscript and revising it critically for important intellectual content; Gluck J was also involved in editing the content; Patel N and Gluck J gave final approval of the submitted content as well as the revised content.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nirav Patel, MD, Department of Cardiology, University of Connecticut, Harford Hospital, 80 Seymour Street, Hartford, CT 06102, United States. nirav.patel@hhchealth.org
Telephone: +1-860-9721793 Fax: +1-860-5453422
Received: March 13, 2017
Peer-review started: March 14, 2017
First decision: April 14, 2017
Revised: May 19, 2017
Accepted: May 22, 2017
Article in press: May 24, 2017
Published online: July 26, 2017
Abstract

The main stay pharmacotherapy for heart failure (HF) is targeted towards rennin-angiotensin-aldosterone (RAAS) and neprilysin pathways (NP). Both therapeutic strategies decreases morbidity and mortality but also carry considerable adverse effects. This review of the literature highlights the new generation of HF drug, sacubitril-valsartan (SV), trade name Entresto (researched as LCZ696, Novartis) which simultaneously blocks RAAS and NP. This dual action of angiotensin receptors blocker and neprilysin inhibitor (NPi) has improved HF prognosis and it is an evolution in the management of HF. Although the initial follow-up of patients treated with SV has yielded promising results, there are concerns regarding potential side effects especially an increase in the risk of Alzheimer’s disease (AD) and young onset of AD. NPi interferes with the breakdown and clearing of beta-amyloid peptides, the plaques seen in AD, raising concern for AD in SV patients. On the other hand, hypertension and cardiovascular diseases are established risk factors for AD which can be decreased by SV therapy. It is therefore essential that SV treated patients are followed up over an extended period of time to detect any adverse cognitive changes.

Keywords: Heart failure, Sacubitril-valsartan, Entresto, LCZ696, Neprilysin inhibitor, Alzheimer’s disease

Core tip: We are discussing an innovative and exciting new treatment for heart failure (HF). This advance in pharmacotherapy has shown promising results and is rapidly incorporating into standard medical therapy for HF. There is, however, a theoretical concern for cognitive dysfunction and early onset Alzheimer’s disease particularly in the young. This review informs clinicians of the mechanism and potential for cognitive dysfunction, thereby increasing awareness and promoting informed prescribing.