Role of angiotensin II receptor blockers in atherosclerotic plaque stability.
Several clinical trials have shown that agents blocking the renin-angiotensin system reduce the incidence of acute ischaemic events. This effect was independent from blood pressure reduction and was presumably related to plaque stabilisation. With the aim of investigating potential mechanisms underlying this effect, carotid plaques were analysed in a recent study from patients randomised to treatment with the angiotensin receptor blocker irbesartan, or the diuretic chlorthalidone for 4 months before carotid endarterectomy. It was found that irbesartan decreased inflammatory infiltration, increased collagen content and downregulated prostaglandin E2-dependent metalloproteases as a consequence of suppression of inducible COX-2/prostaglandin E synthase. This article reviews the results of this study and the most recent evidence that supports the possibility that angiotensin II receptor blockers represent a novel therapy for plaque stabilisation.
Cipollone
Francesco
F
Atherosclerosis Prevention Center, G. d'Annunzio University of Chieti, Via Colle dell'Ara, 66013 Chieti, Italy.
Fazia
Maria Luigia
ML
Mezzetti
Andrea
A
D000804:Angiotensin II / Q000037:antagonists & inhibitors / Q000378:metabolism; D047228:Angiotensin II Type 1 Receptor Blockers / Q000494:pharmacology / Q000627:therapeutic use*; D050197:Atherosclerosis / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D001713:Biphenyl Compounds / Q000494:pharmacology / Q000627:therapeutic use; D002339:Carotid Arteries / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D003094:Collagen / Q000378:metabolism; D051546:Cyclooxygenase 2 / Q000378:metabolism; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D000077405:Irbesartan; D008264:Macrophages / Q000187:drug effects / Q000201:enzymology / Q000473:pathology; D020778:Matrix Metalloproteinase 2 / Q000378:metabolism; D020780:Matrix Metalloproteinase 9 / Q000378:metabolism; D016032:Randomized Controlled Trials as Topic; D013777:Tetrazoles / Q000494:pharmacology / Q000627:therapeutic use
D047228:Angiotensin II Type 1 Receptor Blockers; D001713:Biphenyl Compounds; D013777:Tetrazoles; D000804:Angiotensin II; D003094:Collagen; D051546:Cyclooxygenase 2; D020778:Matrix Metalloproteinase 2; D020780:Matrix Metalloproteinase 9; D000077405:Irbesartan