Impact of Olmesartan on Progression of Coronary Atherosclerosis

Hirohata, Atsushi; Yamamoto, Keizô; Miyoshi, Toru; Hatanaka, Kunihiko; Hirohata, Satoshi; Yamawaki, Hitoshi; Komatsubara, Issei; Murakami, Masaaki; Hirose, Eiki; Sato, Shinji; Ohkawa, Kazushi; Ishizawa, Makoto; Yamaji, Hirosuke; Kawamura, Hiroshi; Kusachi, Shozo; Murakami, Takashi; Hina, Kazuyoshi; Ohe, Tohru

doi:10.1016/j.jacc.2009.09.062

Cited by 104 publications

(24 citation statements)

References 35 publications

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“…In a randomized controlled trial of patients with stable angina pectoris, treatment with olmesartan reduced the atheroma volume detected by intravascular ultrasound. 27 Taken together, our results suggest that in addition to reducing BP, olmesartan may improve cardiovascular outcome independent of treatment with an ACEI.…”

Section: Discussionsupporting

confidence: 52%

Effects of dual blockade of the renin–angiotensin system on renal and cardiovascular outcomes in type 2 diabetes with overt nephropathy and hypertension in the ORIENT: a post-hoc analysis (ORIENT–Hypertension)

et al. 2013

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Combination therapy with angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors (ACEIs) requires further evaluation in patients with diabetic nephropathy and hypertension. In a post hoc analysis of the Olmesartan Reducing Incidence of Endstage renal disease in diabetic Nephropathy Trial with hypertension, we examined the effects of olmesartan on renal and cardiovascular outcomes in the presence or absence of an ACEI. Among 563 patients randomized to receive either olmesartan (n=280) or placebo (n=283), 73.5% (n=414) received a concomitant ACEI. Compared with placebo, olmesartan significantly reduced proteinuria in both the ACEI-treated and non-ACEI-treated groups. The respective changes in the urinary protein creatinine ratio in the olmesartan-treated and placebo-treated groups were −32.6% and +21.1% without an ACEI (P=0.001) and −17.0% and +2.2% with an ACEI (P=0.028). In the olmesartan group, 115 patients developed primary renal outcomes (41.1%) compared with 129 (45.6%) in the placebo group (hazard ratio (HR): 0.97, P=0.787). The respective HRs in the ACEI-treated and non-ACEI-treated groups were 1.02 (P=0.891) and 0.84 (P=0.450). 40 olmesartan-treated patients (14.3%) and 53 placebo-treated patients (18.7%) developed secondary cardiovascular outcomes (HR: 0.65, P=0.042). The respective HRs in the ACEI-treated and non-ACEI-treated groups were 0.69 (P=0.129) and 0.51 (P=0.129). Olmesartan was well tolerated. Dual blockade treatment caused more hyperkalemia than monotherapy. In patients with diabetic nephropathy and hypertension, olmesartan significantly reduced proteinuria, independent of ACEI treatment and cardiovascular outcome but failed to show additional renal benefit compared with ACEI treatment alone. The cardiovascular benefit of dual treatment requires further evaluation.

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Section: Discussionsupporting

confidence: 52%

Effects of dual blockade of the renin–angiotensin system on renal and cardiovascular outcomes in type 2 diabetes with overt nephropathy and hypertension in the ORIENT: a post-hoc analysis (ORIENT–Hypertension)

et al. 2013

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“…Large clinical trials have demonstrated beneficial effects of AT1 receptor blockade in cardiovascular disease that are achieved by lowering blood pressure, slowing the progression of atherosclerosis, and attenuating end-organ damage [32, 33] resulting in decreased morbidity and mortality. Such studies have confirmed the utility of AT1 receptor blockade in patients with cardiovascular and kidney diseases.…”

Section: Introductionmentioning

confidence: 99%

New insights into angiotensin receptor actions: from blood pressure to aging

Stegbauer

Coffman

2011

Current Opinion in Nephrology and Hypertension

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Purpose of the review The renin-angiotensin system (RAS) is critical for cardiovascular control, impacting normal physiology and disease pathogenesis. Although several biologically active peptides are generated by this system, its major actions are mediated by angiotensin II acting through its type 1 (AT1) and type 2 (AT2) receptors. Along with their effects to influence blood pressure and hemodynamics, recent studies have provided evidence that angiotensin receptors influence a range of processes independent from hemodynamic effects. Recent findings This review is focused on new molecular mechanisms underlying actions of AT1 receptors to influence vasoconstriction, inflammation, immune responses, and longevity. Moreover, we also highlight new advances in understanding functions of the AT2 receptor in end-organ damage, emphasizing the AT2 receptor as a potential therapeutic target in cardiovascular diseases. Summary Here we review recent advances in understanding the role of angiotensin receptors in normal physiology and disease states, focusing on their properties that may contribute to blood pressure regulation, end-organ damage, autoimmune disease and longevity.

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“…Furthermore, high level of LDL-C plays a crucial role in the formation of atherosclerotic plaque, but LDL-C level is not unique risk factor for atherosclerotic plaque. Hypertension is another important risk factor for the formation of plaque [48,49]. Smoking cessation, administrating β-blockers, anti-hypertension therapy might play some role in slowing progression of CAP [48,50-52].…”

Section: Discussionmentioning

confidence: 99%

Systematic study of the effects of lowering low-density lipoprotein-cholesterol on regression of coronary atherosclerotic plaques using intravascular ultrasound

Gao

Feng

et al. 2014

BMC Cardiovasc Disord

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BackgroundConflicting results currently exist on the effects of LDL-C levels and statins therapy on coronary atherosclerotic plaque, and the target level of LDL-C resulting in the regression of the coronary atherosclerotic plaques has not been settled.MethodsPubMed, EMBASE, and Cochrane databases were searched from Jan. 2000 to Jan. 2014 for randomized controlled or blinded end-points trials assessing the effects of LDL-C lowering therapy on regression of coronary atherosclerotic plaque (CAP) in patients with coronary heart disease by intravascular ultrasound. Data concerning the study design, patient characteristics, and outcomes were extracted. The significance of plaques regression was assessed by computing standardized mean difference (SMD) of the volume of CAP between the baseline and follow-up. SMD were calculated using fixed or random effects models.ResultsTwenty trials including 5910 patients with coronary heart disease were identified. Mean lowering LDL-C by 45.4% and to level 66.8 mg/dL in the group of patients with baseline mean LDL-C 123.7 mg/dL, mean lowering LDL-C by 48.8% and to level 60.6 mg/dL in the group of patients with baseline mean LDL-C 120 mg/dL, and mean lowering LDL-C by 40.4% and to level 77.8 mg/dL in the group of patients with baseline mean LDL-C 132.4 mg/dL could significantly reduce the volume of CAP at follow up (SMD −0.108 mm3, 95% CI −0.176 ~ −0.040, p = 0.002; SMD −0.156 mm3, 95% CI −0.235 ~ −0.078, p = 0.000; SMD −0.123 mm3, 95% CI −0.199 ~ −0.048, p = 0.001; respectively). LDL-C lowering by rosuvastatin (mean 33 mg daily) and atorvastatin (mean 60 mg daily) could significantly decrease the volumes of CAP at follow up (SMD −0.162 mm3, 95% CI: −0.234 ~ −0.081, p = 0.000; SMD −0.101, 95% CI: −0.184 ~ −0.019, p = 0.016; respectively). The mean duration of follow up was from 17 ~ 21 months.ConclusionsIntensive lowering LDL-C (rosuvastatin mean 33 mg daily and atorvastatin mean 60 mg daily) with >17 months of duration could lead to the regression of CAP, LDL-C level should be reduced by >40% or to a target level <78 mg/dL for regressing CAP.

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Impact of Olmesartan on Progression of Coronary Atherosclerosis

Abstract: These observations suggest a positive role in a potentially lower rate of coronary atheroma progression through the administration of olmesartan, an angiotension-II receptor blocking agent, for patients with stable angina pectoris.

Cited by 104 publications

References 35 publications

Effects of dual blockade of the renin–angiotensin system on renal and cardiovascular outcomes in type 2 diabetes with overt nephropathy and hypertension in the ORIENT: a post-hoc analysis (ORIENT–Hypertension)

Effects of dual blockade of the renin–angiotensin system on renal and cardiovascular outcomes in type 2 diabetes with overt nephropathy and hypertension in the ORIENT: a post-hoc analysis (ORIENT–Hypertension)

New insights into angiotensin receptor actions: from blood pressure to aging

Systematic study of the effects of lowering low-density lipoprotein-cholesterol on regression of coronary atherosclerotic plaques using intravascular ultrasound

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