Blood pressure drug slows aortic dilatation in Marfan syndrome

August 28, 2018

Munich, Germany - 28 Aug 2018: Treatment with a drug to lower blood pressure slows enlargement (dilatation) of the aorta in children and young adults with Marfan syndrome, according to late breaking results from the AIMS trial1 presented today in a Hot Line Session at ESC Congress 2018.2

Dr Michael Mullen, principal investigator, St Bartholomew's Hospital, London, UK, said: "The trial showed a clinically important reduction in the rate of aortic dilatation in children and young adults with Marfan syndrome treated with irbesartan, potentially delaying the need for elective surgery and reducing the risk of complications and death."

Marfan syndrome is an inherited condition which affects one in 5,000-10,000 people. It causes the elastic fibres in the body to become too stretchy, and patients may have very long arms and legs. The aorta, the body's main artery, progressively enlarges, potentially leading to tears, rupture, and death. To prevent these events, surgery to replace the aortic root may be performed when dilatation reaches 4.5-5 cm. Slowing aortic dilatation in Marfan syndrome is an important treatment objective.

Previous studies have shown that beta-blockers, angiotensin-converting enzyme inhibitors, and angiotensin II receptor blockers may reduce the progression of aortic dilation and its complications;3 however, up to 50% of patients with Marfan syndrome cannot tolerate beta-blockers because of side effects.

AIMS is the first randomised trial to evaluate whether the angiotensin receptor blocker irbesartan, a medication used in some patients with high blood pressure, reduces the rate of aortic root dilatation in Marfan syndrome.4 The trial enrolled 192 patients aged six to 40 years from 22 centres in the UK. All patients received a beta-blocker if tolerated. Patients were randomly allocated to irbesartan once daily (150-300 mg depending on body weight) or placebo.

In both treatment groups the median age of participants was 18 years, with 25% aged between six and eleven years. More than half (56%) took beta-blockers during the study. Aortic diameter was assessed using transthoracic echocardiography at baseline and at yearly intervals for up to five years.

During the five-year follow-up, although the aorta continued to enlarge in both groups the rate of dilatation was slower in the irbesartan compared to placebo group (0.53 mm versus 0.74 mm per year, respectively) - a statistically significant reduction of 0.22 mm per year (95% confidence interval 0.02-0.41 mm per year, p=0.030), see figure. The rate of adverse events including the need for cardiac surgery to replace the aortic root was similar in the two groups.

Dr Mullen said: "Our finding of reduced aortic dilatation with irbesartan over and above standard medical therapy suggests an important clinical effect that may prevent complications and ultimately delay or obviate the need for surgical intervention in patients with Marfan syndrome. Importantly, irbesartan was well tolerated, even in children."
-end-
Figure: Aortic diameter over time

Notes to editors

SOURCES OF FUNDING: Funding was through a special project grant from the British Heart Foundation with additional financial support from the UK Marfan Trust and Marfan Association. Irbesartan and matching placebo were supplied under contract by Sanofi PLC. The drug was packaged and distributed by Brecon Pharmaceuticals Ltd.

DISCLOSURES: Dr Mullen has received research funding and payment for teaching from Edwards Lifesciences.

References and notes

1 The Aortic Irbesartan Marfan Study (AIMS) was an investigator led trial sponsored by the Royal Brompton and Harefield NHS Trust, London, UK, and led by Dr Michael Mullen, consultant cardiologist at St Bartholomew's Hospital and Royal Brompton and Harefield NHS Trust, London. Study management was by the Clinical Trials Unit, Royal Brompton Hospital from 2010 until 2015 and by the Clinical Trials Unit, London School of Hygiene & Tropical Medicine from 2015 which also undertook the statistical analysis. The echocardiography core lab was based at John Radcliffe Hospital in Oxford and led by Dr Xuyu Jin.

2 "AIMS - Aortic Irbesartan Marfan Study" will be discussed during:3 Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases. Eur Heart J. 2014 ;35:2873-2926. doi:10.1093/eurheartj/ehu281

4 Mullen MJ, Flather MD, Jin XY, et al. A prospective, randomized, placebo-controlled, double-blind, multicenter study of the effects of irbesartan on aortic dilatation in Marfan syndrome (AIMS trial): study protocol. Trials. 2013;14:408. doi: 10.1186/1745-6215-14-408.

About the European Society of Cardiology

The European Society of Cardiology brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

About ESC Congress 2018

ESC Congress is the world's largest and most influential cardiovascular event contributing to global awareness of the latest clinical trials and breakthrough discoveries. ESC Congress 2018 takes place 25 to 29 August at the Messe München in Munich, Germany. Explore the scientific programme. More information is available from the ESC Press Office at press@escardio.org.

European Society of Cardiology

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