Lack of an effective drug therapy for abdominal aortic aneurysm.
Animals
Anti-Bacterial Agents
/ therapeutic use
Anti-Inflammatory Agents
/ therapeutic use
Antihypertensive Agents
/ therapeutic use
Aortic Aneurysm, Abdominal
/ drug therapy
Aortic Rupture
/ prevention & control
Coronary Artery Disease
/ complications
Disease Models, Animal
Epigenesis, Genetic
Genetic Predisposition to Disease
Humans
Hypertension
/ complications
Hypolipidemic Agents
/ therapeutic use
Platelet Aggregation Inhibitors
/ therapeutic use
Randomized Controlled Trials as Topic
Risk Factors
Smoking
/ adverse effects
aneurysm
aortic
medication
meta-analysis
systematic review
Journal
Journal of internal medicine
ISSN: 1365-2796
Titre abrégé: J Intern Med
Pays: England
ID NLM: 8904841
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
pubmed:
7
7
2019
medline:
2
2
2021
entrez:
7
7
2019
Statut:
ppublish
Résumé
Abdominal aortic aneurysm (AAA) rupture is a common cause of death in adults. Current AAA treatment is by open surgical or endovascular aneurysm repair. Rodent model and human epidemiology, and genetic and observational studies over the last few decades have highlighted the potential of a number of drug therapies, including medications that lower blood pressure, correct dyslipidaemia, or inhibit thrombosis, inflammation or matrix remodelling, as approaches to managing small AAA. This review summarizes prior AAA pathogenesis data from animal and human studies aimed at identifying targets for the development of drug therapies. The review also systematically assesses past randomized placebo-controlled drug trials in patients with small AAAs. Eleven previously published randomized-controlled clinical trials testing different drug therapies aimed at slowing AAA progression were identified. Five of the trials tested antibiotics and three trials assessed medications that lower blood pressure. Meta-analyses of these trials suggested that neither of these approaches limit AAA growth. Allocation to blood pressure-lowering medication was associated with a small reduction in AAA rupture or repair, compared to placebo (relative risk 0.94, 95% confidence intervals 0.89, 1.00, P = 0.047). Three further trials assessed the effect of a mast cell inhibitor, fibrate or platelet aggregation inhibition and reported no effect on AAA growth or clinical events. Past trials were noted to have a number of design issues, particularly small sample sizes and limited follow-up. Much larger trials are needed to properly test potential therapeutic approaches if a convincingly effective medical therapy for AAA is to be identified.
Substances chimiques
Anti-Bacterial Agents
0
Anti-Inflammatory Agents
0
Antihypertensive Agents
0
Hypolipidemic Agents
0
Platelet Aggregation Inhibitors
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
6-22Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2019 The Association for the Publication of the Journal of Internal Medicine.
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