Angiology: Open Access
Open Access

Abstract

Oral Soluble Guanylate Cyclase Stimulators in Heart Failure: A Meta-Analysis of Randomized Controlled Trials

Qiang Ren, Quanyu Zhang* and Sicong Ma*

Background: The impact of Guanylate Cyclase (sGC) stimulators on clinical outcomes of HF patients were still controversial.

Objectives: To investigate the efficacy and safety of oral soluble sGC stimulators in Heart Failure (HF).

Methods: PubMed, Web of Science, and Cochrane Library were searched to identify Randomized Controlled Trials (RCTs) comparing sGC stimulators vs placebo in HF patients. A total of 6 RCTs with 7382 HF patients were included.

Results: Compared with placebo, oral sGC stimulators reduced the risk of a composite of Cardiovascular (CV) death or Hospitalization for HF (HHF), Odd’s Ratio (OR) 0.87, 95% Confidence Interval (CI) 0.78-0.98, p=0.02), and CV death [OR 0.45, 95% CI 0.38-0.53, p<0.001]. Significant reduction in the CV death [OR 0.42, 95% CI 0.35-0.50, p<0.001] of Heart Failure with Reduced Ejection Fraction (HFrEF) was also found in sGC stimulator group. However, certainty of evidence evaluated by Grading of Recommendations Assessment, Development, and Evaluation pro Guideline Development Tool (GRADEproGDT) was moderate or low for the main efficacy outcomes. There was no significant difference between sGC stimulators and placebo in adverse events [OR 0.97, 95% CI 0.86-1.09, p=0.64] or serious adverse events [OR 0.92, 95% CI 0.83-1.03, p=0.14].

Conclusions: Oral sGC stimulators may be associated with a lower risk of CV death or HHF, but the certainty of evidence in this meta-analysis was low. Large-scale, multicenter RCTs with enough statistical power for “hard” efficacy outcomes are urgently needed to determine the impact of sGC stimulators on prognosis of HF.

Published Date: 2024-12-13; Received Date: 2024-11-13