The effects of losartan versus beta-blockers on cardiovascular protection in marfan syndrome: A systematic review and meta-analysis

Abstract

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. Keywords: Angiotensin receptor blocker, Aortic aneurysm, Beta blocker, Losartan, Marfan