Renin-angiotensin system blockade does not attenuate abdominal aortic aneurysm growth, rupture rate, or perioperative mortality after elective repair

Salata, Konrad; Syed, Muzammil H.; Hussain, Mohamad A.; Eikelboom, Rachel; Mestral, Charles de; Verma, Subodh; Al‐Omran, Mohammed

doi:10.1016/j.jvs.2017.09.007

Cited by 19 publications

(12 citation statements)

References 33 publications

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“…While initial results seemed encouraging, larger studies and RCTs found low tolerability of the drug regimen and no beneficial effect of propranolol treatment on AAA expansion [ 211 , 212 , 213 ]. For another class of antihypertensive drugs, inhibitors of angiotensin-converting enzyme (ACE), all but one study revealed no effect on AAA expansion either [ 214 , 215 , 216 , 217 ]. The deviating result originated from a prospective cohort study that intriguingly found increased growth rates in patients taking ACE inhibitors [ 218 ].…”

Section: Diagnosis and Managementmentioning

confidence: 99%

AAA Revisited: A Comprehensive Review of Risk Factors, Management, and Hallmarks of Pathogenesis

et al. 2022

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Despite declining incidence and mortality rates in many countries, the abdominal aortic aneurysm (AAA) continues to represent a life-threatening cardiovascular condition with an overall prevalence of about 2–3% in the industrialized world. While the risk of AAA development is considerably higher for men of advanced age with a history of smoking, screening programs serve to detect the often asymptomatic condition and prevent aortic rupture with an associated death rate of up to 80%. This review summarizes the current knowledge on identified risk factors, the multifactorial process of pathogenesis, as well as the latest advances in medical treatment and surgical repair to provide a perspective for AAA management.

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Section: Diagnosis and Managementmentioning

confidence: 99%

AAA Revisited: A Comprehensive Review of Risk Factors, Management, and Hallmarks of Pathogenesis

et al. 2022

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“…However, whether patients with AA need more stringent blood pressure control goals is currently inconclusive. Antihypertensive drugs, particularly angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers, have been suggested to reduce the rate of AA expansion [ 29 , 30 ], but recent studies do not support this conclusion [ 31 ]. Given the potential benefits of cardiovascular disease treatment, current guidelines recommend that patients with AA and hypertension seek appropriate treatment, although there is no conclusive evidence to support this [ 32–35 ].…”

Section: Discussionmentioning

confidence: 99%

Projection of global burden and risk factors for aortic aneurysm – timely warning for greater emphasis on managing blood pressure

et al. 2022

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Rationale Aortic aneurysm (AA) is a serious condition that largely increases the risk of aortic dissection and sudden death. Exploring the global burden of disease and changes in risk factors for AA is essential for public health policy development. Objective To project the death burden from AA and its attributable risk factors in the following decade based on the epidemiological data over the past 30 years. Methods and Results We analysed the death burden of AA and trends of four risk factors from 1990–2019 using the updated 2019 Global Burden of Disease study database by Joinpoint regression analysis. Furthermore, we project the AA-related death burden for the next decade using the Bayesian age-period-cohort model. This study discovered that the global burden of death attributable to AA began to increase after decreasing for two decades. This upward trend will continue in the subsequent decade (average annual percent change: 0.318%, 95% CI: 0.288 to 0.348). Meanwhile, the disease burdens in all economic regions except high-middle socio-demographic index (SDI) regions will continuously increase in the next decade, with the fastest acceleration in the low-middle SDI region (average annual percent change: 1.183%, 95% CI: 1.166 to 1.200). Notably, high systolic blood pressure will surpass the contribution of smoking to become the most important risk factor for mortality due to AA. Conclusion This study discovered a rebounding trend in the aortic aneurysm-related death burden globally. High systolic blood pressure will be the top risk factor attributed to death from AA. Therefore, it should be considered as the first-degree risk factor in the guidance of AA management and criteria for population-based screening programs. Key messages The death burden of aortic aneurysms is beginning to rebound globally, and the trend will continue for the next decade. High systolic blood pressure will replace smoking as the most important risk factor associated with aortic aneurysm death.

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“…Hyperlipidemia and renin-angiotensin activation are known to be risk factors for AAA progression (Erbel et al 2014), but AAA expansion was not associated with hypercholesterolemia in clinical studies (Lindholt et al 2001;Baxter et al 2008). The efficacy of renin-angiotensin system-inhibiting drugs also remains controversial (Malekzadeh et al 2013;Salata et al 2018).…”

Section: Discussionmentioning

confidence: 99%

A selective antagonist of prostaglandin E receptor subtype 4 attenuates abdominal aortic aneurysm

Yokoyama

Saito

et al. 2018

Physiol Rep

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Abdominal aortic aneurysm (AAA) is a progressive disease that has an increasing prevalence with aging, but no effective pharmacological therapy to attenuate AAA progression is currently available. We reported that the prostaglandin E receptor EP4 plays roles in AAA progression. Here, we show the effect of CJ‐42794, a selective EP4 antagonist, on AAA using two mouse models (angiotensin II‐ and CaCl2‐induced AAAs) and human aortic smooth muscle cells isolated from AAA tissue. Oral administration of CJ‐42794 (0.2 mg/kg per day) for 4 weeks significantly decreased AAA formation in ApoE−/− mice infused with angiotensin II (1 μg/kg per min), in which elastic fiber degradation and activations of matrix metalloproteinase (MMP)‐2 and MMP‐9 were attenuated. Interleukin‐6 (IL‐6) proteins were highly expressed in the medial layer of angiotensin II‐induced mouse AAA tissues, whereas this expression was significantly decreased in mice treated with CJ‐42794. AAA formation induced by periaortic CaCl2 application in wild‐type mice was also reduced by oral administration of CJ‐42794 for 4 weeks. After oral administration of CJ‐42794 beginning 2 weeks after periaortic CaCl2 application and continuing for an additional 4 weeks, the aortic diameter and elastic fiber degradation grade were significantly smaller in CJ‐42794‐treated mice than in untreated mice. Additionally, in smooth muscle cells isolated from human AAA tissues, stimulation of CJ‐42794 inhibited PGE 2‐induced IL‐6 secretion in a dose‐dependent manner and decreased PGE 2‐induced MMP‐2 activity. These data suggest that inhibition of EP4 has the potential to be a pharmacological strategy for attenuation of AAA progression.

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Renin-angiotensin system blockade does not attenuate abdominal aortic aneurysm growth, rupture rate, or perioperative mortality after elective repair

Cited by 19 publications

References 33 publications

AAA Revisited: A Comprehensive Review of Risk Factors, Management, and Hallmarks of Pathogenesis

AAA Revisited: A Comprehensive Review of Risk Factors, Management, and Hallmarks of Pathogenesis

Projection of global burden and risk factors for aortic aneurysm – timely warning for greater emphasis on managing blood pressure

A selective antagonist of prostaglandin E receptor subtype 4 attenuates abdominal aortic aneurysm

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