Table 13

Studies of Medical Treatment of Thoracic Aortic Aneurysm

TreatmentStudiesResults
Beta blockersGenoni M, Paul M, Jenni R, et al (410)Retrospective, case-record review of 78 patients with chronic Type B dissection who received medical treatment. 51 of 71 received beta-blocker treatment, 20 of 71 were treated with other antihypertensive drugs. 10 of 51 (20%) of the beta-blocker–treated patients and 9 of 20 (45%) from the other treatment group needed dissection-related surgery (P=0.002). The incidence of increasing aortic diameter was 12% (6 of 51) in the beta-blocker group and 40% (8 of 20) in the other treatment group (P=0.002).
Shores J, Berger KR, Murphy EA, et al (88)Open-label, randomized, control study of propranolol in 70 patients with Marfan syndrome. The treated group received a mean daily propranolol dose of 212±68 mg/d. Propranolol therapy slowed aortic root dilation (0.023 vs 0.084 per year, P<0.001).
Ladouceur M, Fermanian C, Lupoglazoff JM, et al (411)Retrospective evaluation of aortic dilation in children with Marfan syndrome. Aortic dilatation was slowed by 0.2 mm/y in children treated with beta blockers.
Angiotensin-converting enzyme inhibitorsAhimastos AA, Aggarwal A, D'Orsa KM, et al (412)Randomized, double-blind, placebo-controlled trial of 17 patients with Marfan syndrome taking beta-blocker therapy to perindopril or placebo. After 24 weeks of therapy, the perindopril-treated subjects compared with placebo-treated subjects had smaller growth in the ascending aortic diameter during systole (1.2 vs 0.3 mm/m2, P=0.01) and a significant reduction in ascending aortic diameter during diastole (0.4 vs −1.2 mm/m2, P<0.001), respectively.
Angiotensin receptor blockersMochizuki S, Dahlof B, Shimizu M, et al (413)3081 Japanese patients with hypertension, coronary heart disease, heart failure, or a combination were randomly assigned either to open-label valsartan (40 to 160 mg/d) or to other treatment without angiotension receptor blockers. Patients randomized to valsartan had reduction in composite cardiovascular outcome (OR 0.61, 95% CI 0.47 to 0.79) and reduction in aortic dissection (OR 0.18, 95% CI 0.04 to 0.88). Open-label, randomized.
Brooke BS, Habashi JP, Judge DP, et al (89)The clinical response to angiotension receptor blockers (losartan in 17 patients and irbesartan in 1 patient) were evaluated in pediatric patients with Marfan syndrome with severe aortic root enlargement. The mean (±SD) rate of change in aortic root diameter decreased significantly from 3.54±2.87 mm/y during previous medical therapy to 0.46±0.62 mm/y during angiotension receptor blocker therapy (P<0.001). The deviation of aortic root enlargement from normal, as expressed by the rate of change in z scores, was reduced by a mean difference of 1.47 z scores/y (95% CI 0.70 to 2.24, P<0.001) after the initiation of angiotension receptor blocker therapy. The sinotubular junction showed a reduced rate of change in diameter during angiotension receptor blocker therapy (P<0.05), whereas the distal ascending aorta was not affected by angiotension receptor blocker therapy.
StatinsDiehm N, Decker G, Katzen B, et al (414)A nonrandomized propensity-score–adjusted study of statin use effect on long-term mortality of patients after endovascular repair of AAA (731 patients) or TAA (59 patients) was done. Statin use was associated with decreased long-term mortality in patients with AAA (adjusted HR 0.613, 95% CI 0.379 to 0.993, P=0.047), but not for patients with TAA (adjusted HR 1.795, 95% CI 0.147 to 21.942; P=0.647).

AAA indicates abdominal aortic aneurysm; CI, confidence interval; SD, standard deviation; and TAA, thoracic aortic aneurysm.