sGC stimulators
Soluble Guanylate Cyclase (also termed Guanylyl Cyclase) stimulators (sGCS) and activators reduce oxidative stress by increasing levels of nitric oxide in the heart and blood vessels. These drugs are novel and their use in heart failure is limited. One such sGCS agent is riociguat which is approved for the treatment of specific condition called pulmonary hypertension, which affects blood vessels in the lungs. Another sGCS agent, vericiguat, when added to standard medications, may help to prevent hospitalisation in with severe heart failure.
What they do: Approximately a quarter of heart failure patients have low levels of cyclic guanosine monophosphate (cGMP). The cGMP molecule is a key intracellular messenger, which protects heart, vessels and kidneys. One of the main actions of cGMP is a relaxation of blood vessels and cardiac cells. Soluble Guanylate Cyclase stimulators (sGCS) increase the formation of cGMP, therefore, reduce the stiffness of cardiac cells and vessels.
What are the expected benefits? In patients hospitalised for heart failure who have left ventricular ejection fraction lower than 45%, vericiguat may reduce heart failure-related re-hospitalisations and prolong life.
Side effects: Vericiguat is well tolerated as compared to placebo. Symptomatic hypotension (too low blood pressure) and anemia were reported in a small number of patients.
Top tips: Vericiguat is taken as an oral tablet once daily. As with other medicines for heart failure, the dose is increased slowly in several steps.
