For many people with chronicheart failure两个最近推出的药物可能有助于削减住院的风险，并可能延长他们的生命。
这两种药物，sacubitril /缬沙坦（Entresto）和伊伐布雷定（Corlanor）从美国心脏病学院（ACC），美国心脏协会（AHA）和心力衰竭美国社会最新的心脏衰竭治疗指南-received主要代言（财务监管局）。
In fact, Entresto can now be considered a first-choice therapy, ahead of theACE inhibitorsthat have long been the cornerstone of heart failure treatment.
该药物被美国食品和药物管理局批准，并于2015年来到了市场，使得他们在近十年的批准用于心脏衰竭的第一个新的药物。
Then followed the ACC/AHA/HFSA updated guidelines,published in循环2016年5月，这不能不说明智使用时，药物代表的护理进化患者心脏衰竭的一个“里程碑”。
However, neither drug has been used in the real world long enough to know how it will ultimately affect heart failure patients’ outlook. But based on clinical trials, the hope is that those drugs will make a significant difference for some people.
More living with heart failure
超过500万名美国人患有心脏衰竭，而且这个数字只会继续增长。美国心脏协会预测，近800万美国人将与心脏衰竭住2030-主要是因为人口老龄化。
虽然医学在管理疾病方面取得长足进步，心脏衰竭仍住院和死亡的主要原因。
Each year, heart failure complications send about 1 million Americans to the hospital, and the disease is a leading cause of hospital stays for people age 65 and up.
更重要的是，政府最近的研究发现，经过十几年的下降，心脏衰竭全国死亡率2012年开始后，攀升到2014年，它站在每10万人84人死亡。
还有很长的药物，生活方式措施的同时，可以缓解心脏衰竭症状，减轻心脏应变名单。但是，这种疾病最终发展，创造需要新的治疗选择。
Entresto
Entrestois a twice-a-day pill that combines an old drug, valsartan, with a new one, sacubitril. It was quickly welcomed as a breakthrough treatment by many cardiologists, based on its performance in临床试验发表于The New England Journal of Medicine。
In that study, Entresto prevented more hospitalizations and deaths than the ACE inhibitor enalapril (Vasotec)—one of the mainstay medications for heart failure.
The trial included more than 8,400 patients with moderate to more severe heart failure, plus a reduced ejection fraction, which means that with each heartbeat, the heart’s lower chambers were pumping out much less blood than normal.
患者被随机分配采取每日两次剂量的Entresto或依那普利，除了其他心脏衰竭的药物，他们的医生处方。该试验被提前终止，病人通常沿袭了短短两年后，因为它很清楚，新的药物有更大的收益。
At that point, just under 20 percent of the ACE inhibitor patients had died, versus 17 percent of Entresto patients. The drug specifically cut the risk of hospitalization for heart failure and the risk of death from cardiovascular causes by about 20 percent, compared with enalapril.
• How does it work?Entrestois the first in a new class of medications that target an enzyme called neprilysin. It has two components: valsartan (the active ingredient in the heart failure drug Diovan) and sacubitril, a new drug that inhibits neprilysin. It is believed that in doing so, sacubitril enhances neurohormones that dilate the blood vessels and ease the heart’s workload.
• Is it for you?Officially, Entresto is approved for people with class II, III, or IV heart failure, with a reduced ejection fraction. That translates to a significant portion of Americans with heart failure—about 2.2 million people, according to estimates from Novartis, the drug’s maker.
根据新的治疗指南，Entresto可以被认为是首选的治疗，并且替代地使用ACE抑制剂或血管紧张素II受体阻断剂的。如果你已经对这些药物之一，仍然有心脏衰竭症状，医生可能会建议切换到Entresto。
The drug is not for everyone, however. It has side effects, often related to blood vessel dilation.
In the trial, side effects included low blood pressure that caused symptoms such as dizziness; high potassium levels in the blood, which can raise the risk of a heart arrhythmia; signs of kidney dysfunction; and angioedema—swelling under the skin, often around the eyes and lips.
Low blood pressure and angioedema were the only problems that affected Entresto patients more often than ACE inhibitor patients. But because angioedema can be life-threatening if it interferes with breathing, some caution is in order: You should not take Entresto if you’ve ever had angioedema, and the drug cannot be used with an ACE inhibitor because the combination raises the risk of angioedema.
There’s also a practical consideration: the price tag. Entresto costs about $4,500 a year, whereas ACE inhibitors are available in inexpensive generic versions. However, Medicare does cover Entresto, as do many private insurers.
Corlanor
Corlanor（伊伐布雷定）并没有作出大的一个飞溅Entresto，部分原因是研究结果喜忧参半。
它也有针对性的对心脏衰竭患者的更有限的群体：那些休息心脏率持续高企，尽管使用β受体阻滞剂治疗（每分钟或以上70次）。不过，对于这些人，Corlanor可减少住院的可能性。
该药的批准是基于对谁曾在过去的一年里已经住院心脏衰竭，并有居高不下的休息心脏率（至少每分钟70次）6500例临床试验。
Over roughly two years, patients given Corlanor along with standard therapy were 26 percent less likely to be hospitalized for worsening heart failure, versus patients given a placebo.
Corlanor进来片剂形式，并通过降低心脏率，这有助于减少对心脏的应变工作。这也是其最常见的副作用来源：异常缓慢的心脏速率。
患者大约有10％的临床试验开发了低心脏率，而从2到9％之间的任何开发血压高，atrial fibrillation，或暂时性的视力障碍。
• Is it for you?尽管用β受体阻滞剂的最高耐受剂量治疗Corlanor可能受益心脏衰竭的症状和高静息心脏率的人。请记住，虽然，有关人士提出有关Corlanor的心脏率的影响。
在欧洲，该药物也可用于治疗心绞痛，监管机构提出在2014年进行了旨在减少心绞痛患者的危险缓慢心脏率风险的建议。他们强调，当患者的心脏休息速率为每分钟至少70次的药物，才应使用。
这一警告是基于一个大型试验的心绞痛患者，没有心脏衰竭。但是，这对任何人采取Corlanor要注意的可能迹象表明，药物导致的问题，包括头晕，乏力，心跳加快，或胸部的压力很重要。
和Entresto一样,there’s a hefty price tag: Corlanor costs about $4,500 per year, which may be covered by some insurance plans.
底线
新的选项可供选择，可以帮助让你走出医院或延长你的生命。但它跟你的医生的整体治疗方案，对生活方式的改变和组合是非常重要的药物，可能既延长你的寿命和提高它的质量。
Learn more about how toreduce your risk of heart disease。