The newly FDA-approved heart medication Entresto (valsartan/sacubitril, Novartis) contains an enzyme that may be linked to the development of age-related macular degeneration (AMD), according to an editorial recently published in JAMA

The medication includes a neprilysin inhibitor. Although studies show that inhibiting neprilysin does prevent progression of left ventricular dysfunction, the authors point out that neprilysin “plays a critical role in maintaining the homeostasis of amyloid-β peptide in the brain.” By inhibiting neprilysin, the article posits, the patient may experience an accumulation of amyloid-β peptide. Because research shows that an accumulation of amyloid-β peptide may contribute to the development of AMD, they conclude that, while the medication does assist in heart conditions, it has the potential to increase the risk of AMD and Alzheimer’s disease.

“I applaud the JAMA editorial for calling for more rapid assessment of AMD and Alzheimer’s disease through collaborative partnerships,” says A. Paul Chous, OD, whose practice focuses on diabetes eye care and education. However, he says, the risk may be worthwhile. “Evidence shows that, in patients diagnosed with heart failure, only one in three survive more than five years. This mortality statistic mitigates, at least to some extent, the potential ocular and neurologic harm posed by increased amyloid-β with this combination of an angiotensin blocker and neprilysin inhibitor.” Increased amyloid-β peptide is associated with beta cell failure as seen in Type 2 diabetes mellitus and glaucoma, he adds. 

“It also makes sense to carefully monitor patients for these sequelae,” he says.