September 2nd, 2013
Losartan Reduces Aortic Enlargement in Marfan Syndrome
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A small study from the Netherlands provides the first confirmation that the angiotensin receptor blocker losartan can help prevent the aortic enlargement that may presage the catastrophic aortic dissection often associated with Marfan syndrome. Many Marfan patients have been taking losartan following the publication of a groundbreaking mouse study in 2006.
“Our study is the first large, prospective randomized study to assess the effects of losartan on aortic enlargement in adults with Marfan syndrome, and confirms previous findings in a mouse model,” said lead investigator of the COMPARE study, Maarten Groenink, in an ESC press release. COMPARE was presented at the European Society of Cardiology meeting in Amsterdam and published simultaneously in the European Heart Journal.
A total of 233 Marfan patients were randomized to losartan or placebo in addition to standard therapy with beta blockers. Groenink reported that the rate of aortic dilatation over 3 years was significantly lower in the losartan group than in the placebo group (0.77 mm vs. 1.35 mm, p=0.014). One-half of the patients in the losartan group had no growth of the aortic root compared with 31% of controls (p=0.022).
The effect was consistent across all subgroups examined. There were no significant differences in the aortic dilatation rate beyond the aortic root, except in the aortic arch for the group of patients who had had aortic root replacement. There were few clinical events in both groups. Eight patients in the control group and 10 patients in the losartan group underwent aortic root surgery. One control patient had distal aortic surgery and 2 control patients had a type B aortic dissection.
“We’re very excited to see that such a commonly used drug that is not expensive and has a familiar side-effect profile could have a significant effect on this very serious and frightening risk factor for these patients,” said Groenink. “These findings may change standard clinical management.”
For Fellow Paddy Barrett’s take on COMPARE, read his blog here.