Effects of Valsartan, an Angiotensin II Receptor Blocker, on Coronary Atherosclerosis in Patients With Acute Myocardial Infarction Who Receive an Angiotensin-Converting Enzyme Inhibitor

Hideto Yano; Kiyoshi Hibi; Naoki Nozawa; Hiroyuki Ozaki; Ikuyoshi Kusama; Toshiaki Ebina; Masami Kosuge; Kengo Tsukahara; Jun Okuda; Satoshi Morita; Satoshi Umemura; Kazuo Kimura

doi:10.1253/circj.CJ-11-1102

Ischemic Heart Disease

Effects of Valsartan, an Angiotensin II Receptor Blocker, on Coronary Atherosclerosis in Patients With Acute Myocardial Infarction Who Receive an Angiotensin-Converting Enzyme Inhibitor

Hideto Yano, Kiyoshi Hibi, Naoki Nozawa, Hiroyuki Ozaki, Ikuyoshi Kusama, Toshiaki Ebina, Masami Kosuge, Kengo Tsukahara, Jun Okuda, Satoshi Morita, Satoshi Umemura, Kazuo Kimura

Author information

Hideto Yano
Division of Cardiology, Yokohama City University Medical Center
Kiyoshi Hibi
Division of Cardiology, Yokohama City University Medical Center
Naoki Nozawa
Division of Cardiology, Yokohama City University Medical Center
Hiroyuki Ozaki
Division of Cardiology, Yokohama City University Medical Center
Ikuyoshi Kusama
Division of Cardiology, Yokohama City University Medical Center
Toshiaki Ebina
Division of Cardiology, Yokohama City University Medical Center
Masami Kosuge
Division of Cardiology, Yokohama City University Medical Center
Kengo Tsukahara
Division of Cardiology, Yokohama City University Medical Center
Jun Okuda
Division of Cardiology, Yokohama City University Medical Center
Satoshi Morita
Department of Biostastics and Epidemiology, Yokohama City University Medical Center
Satoshi Umemura
Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine
Kazuo Kimura
Division of Cardiology, Yokohama City University Medical Center

Keywords: Acute myocardial infarction, Angiotenisn II receptor blocker, Atherosclerosis, Intravascular ultrasound

JOURNAL FREE ACCESS

2012 Volume 76 Issue 6 Pages 1442-1451

DOI https://doi.org/10.1253/circj.CJ-11-1102

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Abstract

Background: The aim of the present study was to assess the effects of angiotensin II receptor blocker (ARB) on coronary plaque progression in patients with acute myocardial infarction (AMI) who received an angiotensin-converting enzyme inhibitor (ACEI). Methods and Results: After local ethics committee approval and obtaining of informed consent, 116 patients with AMI were randomly assigned to receive a combination of valsartan and captopril or captopril alone. Non-culprit intermediate coronary atherosclerosis was assessed on intravascular ultrasound. The primary and secondary endpoints were the nominal change in percent atheroma volume (PAV) and percent change in lumen volume (%ΔLV), respectively. The combination group had a significantly lower systolic blood pressure (117 vs. 125mmHg; P=0.02) and a lower plasma aldosterone level (56 vs. 75pg/ml; P=0.02) at follow-up. The nominal change in PAV was slightly lower in the combination group than in the ACEI group (-1.9 vs. -0.68%, P=0.06). %ΔLV was -0.3% in the ACEI group and was 4.3% in the combination group (P=0.03). Logistic regression analysis showed that additional ARB therapy was independently associated with LV enlargement (odds ratio, 2.144; 95% confidence interval: 1.818-5.618; P=0.03). Conclusions: In this study of patients with AMI, additional ARB therapy had minimal impact on the progression of coronary atherosclerosis as compared with an ACEI alone. The combination of these 2 drugs, however, induces coronary artery enlargement. (Circ J 2012; 76: 1442-1451)

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