Vascular protecting effect of angiotensin receptor blocker (ARB) on the radial artery graft
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Mitsumasa Hata1, Akira Sezai, Tetsuya Niino
1Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan.
Insights
Angiotensin receptor blockers (ARBs) and ACE inhibitors showed similar effects on radial artery endothelium one year after coronary bypass surgery. ARBs demonstrated a beneficial effect on cholesterol levels.
Area of Science:
- Cardiovascular Surgery
- Pharmacology
- Vascular Biology
Background:
- Coronary artery bypass grafting (CABG) is a common surgical procedure.
- Endothelial damage to arterial grafts can impact long-term patency.
- Angiotensin receptor blockers (ARBs) and ACE inhibitors are classes of drugs that modulate the renin-angiotensin-aldosterone system.
Purpose of the Study:
- To compare the vascular protecting effects of an ARB (Candesartan) versus an ACE inhibitor (Imidapril) on radial artery (RA) endothelium after CABG.
- To investigate if ARBs reduce endothelial damage in the RA graft.
Main Methods:
- A comparative study involving 164 patients undergoing CABG.
- Patients were randomized to receive either Candesartan 8 mg/day (Group C, n=92) or Imidapril 5 mg/day (Group I, n=72).
- Graft angiography and RA intima evaluation via angioscopy were performed one year post-surgery.
Main Results:
- Group C (ARB) showed significantly lower total cholesterol (151.4 vs. 182.2 mg/dL) and LDL cholesterol (96.1 vs. 139.1 mg/dL) compared to Group I (ACE inhibitor).
- Yellow plaque was observed in the proximal RA in 8.0% of Group C patients versus 11.6% of Group I patients, indicating a trend towards less plaque in the ARB group.
- No significant difference in RA endothelial effects was found between the two groups upon angioscopic evaluation.
Conclusions:
- One year after CABG, ARBs and ACE inhibitors exhibited comparable effects on the radial artery endothelium.
- ARBs were associated with a significant reduction in total and LDL cholesterol levels.
- The cholesterol-lowering effect of ARBs was supported by both blood examination data and endoscopic findings.
Purpose:
We hypothesized that the vascular protecting effect of an angiotensin receptor blocker (ARB) reduced endothelial damage of the radial artery (RA) after coronary bypass and conducted a comparative study.
Patients And Methods:
One hundred and sixty four patients were divided into the following two groups, Group C: 92 subjects who were orally administered Candesartan 8 mg/day, Group I: 72 subjects who were administered Imidapril at 5 mg/day. Graft angiography was performed one year after surgery and the RA intima was evaluated using an angioscope.
Results:
Total cholesterol of Group C was 151.4+/-66.9 mg/dL, which was significantly lower than in Group I (182.2+/-27.8 mg/dL), and LDL cholesterol of the ARB-treated group, i.e., Group C was 96.1+/-32.5 mg/dL and significantly lower than in Group I (139.1+/-48.7 mg/dL). In angioscopy, yellow plaque was detected in the proximal RA in 7 (8.0%) and 8 (11.6%) patients of the Groups C and I, respectively, showing a lower tendency in the ARB-treated group.
Conclusions:
The results of evaluation one year after surgery revealed no significant difference in effects on the RA endothelium between ARB and ACE inhibitor. ARB reduced cholesterol and its effect was confirmed with blood examination data and endoscopic findings.
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