title: Losartan reduces aortic dilatation rate in adults with Marfan syndrome: a randomized controlled trial.
abstract: OBJECTIVE
  Patients with Marfan syndrome have an increased risk of life-threatening aortic complications, mostly preceded by aortic dilatation. Treatment with losartan, an angiotensin-II receptor-1 blocker, may reduce aortic dilatation rate in Marfan patients.
  
  
  RESULTS
  In this multicentre, open-label, randomized controlled trial with blinded assessments, we compared losartan treatment with no additional treatment in operated and unoperated adults with Marfan syndrome. The primary endpoint was aortic dilatation rate at any predefined aortic level after 3 years of follow-up, as determined by magnetic resonance imaging. A total of 233 participants (47% female) underwent randomization to either losartan (n = 116) or no additional treatment (n = 117). Aortic root dilatation rate after 3.1 ± 0.4 years of follow-up was significantly lower in the losartan group than in controls (0.77 ± 1.36 vs. 1.35 ± 1.55 mm, P = 0.014). Aortic dilatation rate in the trajectory beyond the aortic root was not significantly reduced by losartan. In patients with prior aortic root replacement, aortic arch dilatation rate was significantly lower in the losartan group when compared with the control group (0.50 ± 1.26 vs. 1.01 ± 1.31 mm, P = 0.033). No significant differences in separate clinical endpoints or the composite endpoint (aortic dissection, elective aortic surgery, cardiovascular death) between the groups could be demonstrated.
  
  
  CONCLUSIONS
  In adult Marfan patients, losartan treatment reduces aortic root dilatation rate. After aortic root replacement, losartan treatment reduces dilatation rate of the aortic arch.
authors.affiliation: Department of Cardiology, Academic Medical Centre Amsterdam, Rm. F3-147, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
authors.forename: Maarten
authors.initials: M
authors.lastname: Groenink
authors.forename: Alexander W
authors.initials: AW
authors.lastname: den Hartog
authors.forename: Romy
authors.initials: R
authors.lastname: Franken
authors.forename: Teodora
authors.initials: T
authors.lastname: Radonic
authors.forename: Vivian
authors.initials: V
authors.lastname: de Waard
authors.forename: Janneke
authors.initials: J
authors.lastname: Timmermans
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Scholte
authors.forename: Maarten P
authors.initials: MP
authors.lastname: van den Berg
authors.forename: Anje M
authors.initials: AM
authors.lastname: Spijkerboer
authors.forename: Henk A
authors.initials: HA
authors.lastname: Marquering
authors.forename: Aeilko H
authors.initials: AH
authors.lastname: Zwinderman
authors.forename: Barbara J M
authors.initials: BJ
authors.lastname: Mulder
mesh_terms: D000328:Adult; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage*; D001013:Aorta, Thoracic / Q000473:pathology; D001018:Aortic Diseases / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D004108:Dilatation, Pathologic / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D019808:Losartan / Q000008:administration & dosage*; D018810:Magnetic Resonance Angiography; D008297:Male; D008382:Marfan Syndrome / Q000150:complications* / Q000473:pathology; D012086:Reoperation; D016896:Treatment Outcome
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D019808:Losartan
keywords: Aortic dilatation rate; Aortic root; Losartan; Magnetic resonance imaging; Marfan syndrome