The effects of losartan versus beta-blockers on cardiovascular protection in marfan syndrome: A systematic review and meta-analysis
Journal
Journal of the Formosan Medical Association
Journal Volume
119
Journal Issue
1P1
Pages
182-190
Date Issued
2020
Author(s)
Abstract
Background and purpose: Variable effects of beta-blockers (BB) and/or angiotensin receptor blockers (ARB) were reported to retard aortic root growth in Marfan syndrome (MFS). This study aimed to compare the effects of BB therapy and ARB-related therapies on cardiovascular protection in MFS. Methods: Studies of randomized control trials comparing the efficacy of only-BB and ARB-related (only-ARB or ARB-plus-BB) therapies for MFS published before July 31, 2018 in PubMed, Embase, and the Cochrane Library were selected. The outcomes included changes in aortic growth and cardiovascular events. Results: Eight trials involving 1381 patients were included. Patients received only-BB and ARB-related therapies did not differ significantly in changes in aortic growth (aortic root diameter: standardized mean difference [SMD] = 0.04, 95% confidence interval [CI]: ?0.11–0.19, p = 0.63) or cardiovascular events (aortic dissection: Peto odds ratio [OR] = 1.67, 95% CI: 0.42–6.72, p = 0.47; aortic surgery: risk ratio = 0.97, 95% CI: 0.66–1.41, p = 0.86; death: Peto OR = 2.78, 95% CI: 0.39–19.82, p = 0.31). Subgroup analysis revealed that ARB-plus-BB therapy exhibited nonsignificantly better outcomes than only-BB therapy (aortic root diameter: SMD = 0.11, 95% CI: ?0.22–0.45, p = 0.52; ascending aorta diameter: SMD = 0.10, 95% CI: ?0.07–0.27, p = 0.26; aortic surgery: Peto OR = 1.10, 95% CI: 0.75–1.61, p = 0.62). Conclusion: For cardiovascular protection in MFS, only-ARB therapy is not inferior to only-BB therapy. Moreover, the outcomes of ARB-plus-BB therapy seemed to be favourable to those of only-BB therapy. ? 2019 Formosan Medical Association
Subjects
Angiotensin receptor blocker; Aortic aneurysm; Beta blocker; Losartan; Marfan
SDGs
Other Subjects
beta adrenergic receptor blocking agent; losartan; angiotensin receptor antagonist; beta adrenergic receptor blocking agent; cardiotonic agent; losartan; aortic dissection; aortic surgery; Article; cardiovascular risk; Cochrane Library; comparative effectiveness; drug effect; Embase; heart protection; human; Marfan syndrome; Medline; meta analysis; outcome assessment; quality control; systematic review; aortic disease; combination drug therapy; lesions and defects; Marfan syndrome; randomized controlled trial (topic); treatment outcome; Adrenergic beta-Antagonists; Angiotensin Receptor Antagonists; Aortic Diseases; Cardiotonic Agents; Dilatation, Pathologic; Drug Therapy, Combination; Humans; Losartan; Marfan Syndrome; Randomized Controlled Trials as Topic; Treatment Outcome
Publisher
Elsevier B.V.
Type
journal article