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Losartan reduced aortic root enlargement in Marfan syndrome
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AMSTERDAM — Losartan, an angiotensin II receptor antagonist, reduced the rate of aortic enlargement in patients with Marfan syndrome, according to data presented at ESC Congress 2013.
Marfan syndrome is a heritable connective tissue disorder that affects two to three of 10,000 people. “Gradual aortic enlargement occurs in these patients until an aneurysm develops. These areas are prone for rupture or dissection or tearing of the wall,” which is often fatal, Maarten Groenink, MD, PhD, of the departments of cardiology and radiology at Academic Medical Centre in Amsterdam, said during a press conference. Current treatments, he said, are beta-blockers to lower BP and surgery to replace the aortic root.
Maarten Groenink
Groenink and colleagues enrolled 233 patients with Marfan syndrome (mean age, 41 years; 47% women) in the COMPARE study from Marfan syndrome screening centers in the Netherlands. About half of the patients were assigned losartan (Cozaar, Merck) 50 mg daily (increasing to 100 mg after 14 days if tolerated) and the rest were assigned placebo. The researchers used MRI to assess aortic enlargement at baseline and after 3 years.
After 3 years, aortic root enlargement was less in the losartan group vs. the placebo group (0.77 mm vs. 1.35 mm; P=.014). Among those assigned losartan, 50% experienced no growth in the aortic root vs. 31% of those assigned placebo (P=.022). In the subset of patients who had already undergone aortic root replacement surgery, dilation in the aortic arch was 0.5 mm for those assigned losartan vs. 1.01 mm for those assigned placebo (P=.033). There was no effect in other parts of the aorta, Groenink said.
There was no difference between groups in rate of aortic dissections or elective aortic surgery, and there were no CV deaths.
The COMPARE trial was launched after experiments on mice revealed that losartan interfered with the process that triggers aortic enlargement, Groenink said.
“The mouse experiments had been performed with losartan. … We believe it to be a class effect, but we are not sure about that,” he said.
For more information:
Groenink M. Hot Line III: Late breaking trials on risk factors and diabetes. Presented at: the European Society of Cardiology Congress; Aug. 31-Sept. 4, 2013; Amsterdam.
Disclosure: The researchers report no relevant financial disclosures.