Impact of sacubitril/valsartan on lipid parameters in patients with heart failure with reduced ejection fraction
I Aydin, H A Barman, O Dogan, S Ozyildirim, Ş İL KE Ebeoglu, S Tanyolac, E Bal, Z YigitAbstract
Background/Introduction
Long-term modulation of lipid metabolism by angiotensin receptor–neprilysin inhibition remains insufficiently characterised in heart failure with reduced ejection fraction. Previous studies suggest potential metabolic effects through neprilysin inhibition and enhanced natriuretic peptide signalling.
Purpose
To assess the longitudinal impact of sacubitril/valsartan on lipid parameters and N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations over 3 years in symptomatic heart failure with reduced ejection fraction.
Methods
A retrospective cohort of adults receiving sacubitril/valsartan for symptomatic heart failure with reduced ejection fraction was evaluated. Lipid parameters and NT-proBNP were collected at baseline and periodic visits for up to 36 months. Analyses were performed in the overall population and stratified by statin exposure. Outcomes were compared with baseline values using repeated-measure statistics.
Results
A total of 192 patients were analysed. Across the cohort, sacubitril/valsartan was associated with progressive reductions in total cholesterol (196.1 ± 44.8 to 161.5 ± 41.7 mg/dL at year 3) and triglycerides (159.1 ± 10.4 to 121.4 ± 6.9 mg/dL), with sustained improvement versus baseline (all p<0.001). High-density lipoprotein cholesterol increased during follow-up (44.9 ± 17.1 to 48.2 ± 2.4 mg/dL at year 3; p<0.001). NT-proBNP concentrations decreased consistently over time (3916 to 882 pg/mL; p<0.001). These trends were directionally preserved in both statin-treated and statin-free subgroups, indicating metabolic effects independent of concurrent lipid-lowering therapy.
Conclusion(s)
In symptomatic heart failure with reduced ejection fraction, sacubitril/valsartan is associated with favourable modulation of lipid metabolism;lower total cholesterol and triglycerides with improved high-density lipoprotein cholesterol,together with significant reductions in NT-proBNP during 3-year follow-up. These findings support complementary metabolic benefits of neprilysin inhibition beyond neurohormonal modulation and may contribute to long-term cardiovascular risk reduction.Long-term lipid changes in statin usersFor image description, please refer to the figure legend and surrounding text.Long-term lipid changes without statinsFor image description, please refer to the figure legend and surrounding text.