Key result
ARB-related therapies show no benefit over BB monotherapy for aortic root growth in Marfan syndrome.
Why the study?
Variable effects of beta-blockers and angiotensin receptor blockers on aortic root growth and cardiovascular protection in Marfan syndrome were reported, necessitating comparison of their efficacy.
Does ARB-related therapy improve cardiovascular protection compared to beta-blocker therapy in patients with Marfan syndrome?
Meta-Analysis (n=1,381)
Does ARB-related therapy improve cardiovascular protection compared to beta-blocker therapy in patients with Marfan syndrome?
Standardized Mean Difference: 0.04 (95% CI -0.11–0.19)
p-value: p=0.63
ARB therapy is not inferior to beta-blocker therapy for cardiovascular protection in Marfan syndrome, with combination therapy showing a non-significant trend toward better outcomes.
ARBs are comparable to beta-blockers for aortic root protection in Marfan syndrome; confirms similar efficacy without added benefit from ARB regimens.
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.
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Kang et al. (2019) conducted a meta-analysis in Marfan syndrome (n=1,381). ARB-related therapies (only-ARB or ARB-plus-BB) vs. Only-beta-blocker therapy was evaluated on changes in aortic growth (aortic root diameter) (SMD 0.04, 95% CI -0.11-0.19, p=0.63). ARB-related therapies did not differ significantly from only-beta-blocker therapy in changes in aortic root diameter (SMD 0.04; 95% CI -0.11-0.19; p=0.63) in patients with Marfan syndrome.
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