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Olmesartan may slow coronary atheroma progression in patients with stable angina

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Findings from a new study provide the first evidence that an angiotension-II receptor blocking agent may reduce progression of coronary atherosclerosis.

Researchers from several sites in Japan enrolled 247 patients with stable angina and native CAD in the OLIVUS trial, a prospective, randomized, multicenter study to measure the effect of olmesartan on progression to coronary atherosclerosis after PCI. They randomly assigned patients to either olmesartan (10 mg to 40 mg) or a combination of CV drugs including beta-blockers, calcium channel blockers, diuretics, nitrates, glycemic control agents and/or statins per physician’s guidance.

Coronary atheroma volume was assessed in nonculprit coronary vessels with serial volumetric IVUS at baseline and again at 14-month follow-up. A total of 205 patients (control, n=102; olmesartan, n=109) completed the analyses; patient characteristics and BP control were identical in both groups.

The researchers observed significant plaque progression in the control group at 14 months (total atheroma volume increased from 208.8 mm³ to 215.9 mm³), but no change in the olmesartan group. Furthermore, the control group experienced a mean total atheroma volume percent change of 5.4% vs. a 0.6% change in the olmesartan group (P=.016). Although percent atheroma volume increased among control patients, it decreased among patients in the olmesartan group (3.1% vs. –0.7%; P=.038).

“Compared with previous studies, results of the present study seem to show convincing serial changes of coronary atheroma volume,” the researchers wrote.

Steven P. Marso, MD, of Saint Luke’s Mid America Heart Institute at the University of Missori-Kansas City, called the findings preliminary, but suggested that in the future IVUS may help identify high-risk regions for future MI. “Undoubtedly, there will be interest in plaque-modifying interventions designed to lower individual risk for mortal and morbid CV events.”

Hirohata A. J Amer Coll Card. 2010;55:976-982.

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