Is losartan the true panacea for aneurysm disease? PRO

Aortic aneurysms remain a common medical condition in the twenty-first century. Although surgical repair remains the standard of care for patients with enlarging and advanced aneurysmal disease, new insights into the pathogenesis of aortic aneurysm have resulted in an interest in targeting these pathways and reducing the rate of aneurysm expansion. The renin-angiotensin system is known to play a role in inflammation and aneurysm formation through nuclear factor-kappaB and expression of matrix degrading enzymes. Recent work also suggests that angiotensin receptor blockade may also disrupt transforming growth factor beta1 signaling, resulting in a reduced rate of aneurysm expansion. These animal data, combined with recent retrospective trials showing markedly reduced rates of aortic root dilation in patients with Marfan syndrome treated with angiotensin receptor blockers, suggest a powerful role for angiotensin receptor blockers in the treatment of aortic aneurysms.