Effects of Combined Treatment with Angiotensin II Type 1 Receptor Blocker and Statin on Stent Restenosis

Abstract

Angiotensin II type I receptor blocker (ARB) or statin has been reported to be effective in preventing stent restenosis, but little is known about the combined effect on stent restenosis. The objective of this study was to determine the effect of combination therapy with ARB and statin on restenosis rate after coronary stenting and on proliferation and migration of and reactive oxygen species (ROS) production by human coronary artery smooth muscle cells (SMCs) in vitro. Clinical data were collected from 330 consecutive patients who underwent coronary stenting for de novo lesions. Six months after stenting, quantitative coronary angiography was performed. Combined therapy with the ARB and statin significantly inhibited stent restenosis (P < 0.05) compared with the effect of the ARB or statin alone. In an in vitro study, platelet-derived growth factor (PDGF)-induced proliferation was significantly inhibited by combined treatment with CV11974, an ARB, and simvastatin (P < 0.01), but the inhibitory effect was not significantly greater than that of simvastatin alone. Migration of human coronary artery SMCs was significantly inhibited by the ARB + statin compared with the effect of the ARB or statin alone (P < 0.01). PDGF-induced production of ROS was also inhibited significantly by the ARB + statin compared with the effect of the ARB or statin alone (P < 0.01). These results indicate that inhibitory effects of combined therapy on PDGF-induced migration of and ROS production by SMCs play an important role in reduction of restenosis rate. Combined treatment with ARB and statin after stenting is useful for preventing stent restenosis.

Angiotensin receptor blockers and antiplatelet agents are associated with improved primary patency after arteriovenous hemodialysis access placement

“…16 ARBs also play a role in three mechanisms that may prolong access patency: promoting venous dilation, 17,18 preventing platelet activation, 19,20 and inhibiting neointimal hyperplasia. [21][22][23][24][25][26][27][28][29] Our data suggest that the association of ARB with autogenous AV access patency is potentiated by use of antiplatelet medication. Improved autogenous access patency may rely on the combined effects of ARB-induced venous dilation and prevention of stenosis and antiplatelet inhibition of platelet function.…”

Differential Metabolic Actions of Specific Statins: Clinical and Therapeutic Considerations

“…1) (47, 60, 72). Therefore, it has been proposed that a combined therapy with statins or PPAR agonists and RAAS blockers to target multiple therapeutic pathways might provide the optimal treatment (14,47,119).…”

Neointimal Hyperplasia Inhibition Effect of Angiotensin II Type 1 Receptor Blockers in Patients after Coronary Stent Implantation

“…Sixteen of these studies were excluded for the following reasons: three of them were not clinical trials; [1,2,4] three of them compared different types or dosages of ARBs rather than comparing the risks with and without an ARB; [5][6][7] four studies provided none of the outcomes of interest; [8][9][10][11] two studies reported only stent number and not patient number; [12,13] the other four studies were excluded because they were not randomized controlled trials. [14][15][16][17] Finally, five studies with a total number of 624 patients met the inclusion criteria [18][19][20][21][22] (figure 1).…”