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Cardiovasc Ther. 2017;35(5):e12291.

Predictors of candesartan's effect on vascular reactivity in patients with coronary artery disease.

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제1저자 이소령, 채인호 · 교신저자 김효수, 김상현

PMID 28796934 PMC5639377 DOI 10.1111/1755-5922.12291 IF 2.8 순환기내과
소속 (3)
  1. Division of Cardiology, Department of Internal Medicine/Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
  2. Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
  3. Division of Cardiology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.

Abstract

INTRODUCTION AND AIMS Endothelial dysfunction and arterial stiffness have a prognostic value on adverse long-term outcomes in coronary artery disease (CAD) patients. We evaluated the efficacy on vascular reactivity of candesartan and analyzed predictors to control the candesartan's effect on vascular reactivity in CAD patients.

METHOD Patients were prospectively enrolled and prescribed candesartan for 6 months. The effect on vascular reactivity was evaluated by the change in flow-mediated dilation (FMD) and pulse wave velocity (PWV).

RESULTS A total of 124 patients completed the study. The better responder in FMD change (≥1.3%) showed significantly lower baseline FMD than the poor responder (P < .001). In receiver operating characteristic analysis, baseline FMD 7.5% showed optimal predictive value (sensitivity 79%, specificity 79%) for predicting better responder. The baseline endothelial dysfunction (FMD <7.5%) was the only significant predictor of the better responder to candesartan. The better responder in PWV change (≤-100 cm/s) showed greater blood pressure lowering and significantly higher baseline PWV than the poor responder (both P < .05). The poor responder in both FMD and PWV showed a higher prevalence of previous myocardial infarction (38.7% vs 17.2%, P = .013).

CONCLUSION The candesartan's effect on vascular reactivity is more pronounced in patients with more severe endothelial dysfunction and arterial stiffness. Poor responders on both FMD and PWV showed higher prevalence of previous myocardial infarction.

© 2017 The Authors. Cardiovascular Therapeutics Published by John Wiley & Sons Ltd.

Keywords

Angiotensin II type 1 receptor blockersArterial stiffnessEndothelial dysfunctionFlow-mediated dilationPulse wave velocity

Figures

Figure 1
Figure 1 Relation between FMD and PWV. (A) Scatterplot showing the significant inverse relation between baseline FMD and change of FMD (r = −.610, P < .001). (B) Scatterplot of baseline PWV and change of PWV. There was a modest inverse correlation (r = −.373, P < .001). (C) Relation between baseline FMD and PWV. Scatterplot showing that there was no statistically significant relation between baseline FMD and PWV (r = .073, P = .422). (D) Relation between 24‐week FMD and PWV. Scatterplot showing that there was no statistically significant relation between 24‐week FMD and PWV (r = .09, P = .318). FMD, flow‐mediated dilation; PWV, pulse wave velocity
Figure 2
Figure 2 ROC curve of the baseline FMD and PWV for predicting better responder. (A) ROC curve of the baseline FMD for predicting better responder of FMD. AUC was 0.815 (95% CI 0.740‐0.891, P < .001), and baseline FMD 7.5% showed optimal predictive value (sensitivity 79%, specificity 79%). (B) ROC curve of the baseline PWV for predicting better responder of PWV. AUC was 0.645 (95% CI 0.548‐0.742, P = .005), and baseline PWV 1553 cm/s was optimal predictive value (sensitivity 68%, specificity 58%). AUC, area under the curve; FMD, flow‐mediated dilation; PWV, pulse wave velocity; ROC, receiver operating characteristic
Figure 3
Figure 3 Scatterplot showing the correlation between change in FMD and PWV (P = .733). Poor responder to candesartan in both FMD and PWV defined as change in FMD less than 1.3% and change in PWV more than −100 cm/s. Poor responder (both FMD and PWV, n = 31) showed a higher prevalence of previous MI than other patients group (38.7% vs 17.2%, P = .013). FMD, flow‐mediated dilation; MI, myocardial infarction; PWV, pulse wave velocity

그림 출처: PubMed Central 공개 논문 (PMC5639377)

그 밖의 정보
출판 형태
Clinical Trial, Phase IV, Journal Article, Multicenter Study, Randomized Controlled Trial
저널
Cardiovascular therapeutics · eISSN 1755-5922
MeSH
Aged · Angiotensin II Type 1 Receptor Blockers / adverse effects / therapeutic use · Benzimidazoles / adverse effects / therapeutic use · Biphenyl Compounds · Brachial Artery / drug effects / physiopathology · Coronary Artery Disease / diagnostic imaging / drug therapy / epidemiology / physiopathology · Coronary Stenosis / diagnostic imaging / drug therapy / epidemiology / physiopathology · Female · Humans · Male · Middle Aged · Myocardial Infarction / epidemiology · Prevalence · Prospective Studies · Pulse Wave Analysis · Seoul / epidemiology · Tetrazoles / adverse effects / therapeutic use · Time Factors · Treatment Outcome · Vascular Stiffness / drug effects · Vasodilation / drug effects
Substances
Angiotensin II Type 1 Receptor Blockers · Benzimidazoles · Biphenyl Compounds · Tetrazoles · candesartan
참고문헌
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