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DOI: 10.12945/j.aorta.2013.13.002
Do β-Blockers Really Work for Prevention of Aortic Aneurysms?
Time for ReassessmentPublication History
09 January 2013
08 March 2013
Publication Date:
28 September 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00039245/201301/lookinside/thumbnails/10-12945-j-aorta-2013-13-002_0113045-1.jpg)
Abstract
Since 1994, when a small 70-patient study seemed to demonstrate that β-blocker treatment could help prevent aortic aneurysms in patients with Marfan syndrome, β-adrenergic–blocking drugs have been increasingly believed to reduce the progression of aortic aneurysms in the general population with aortic disease. This literature review examines the scientific evidence of this treatment and questions whether β-blocker treatment for aortic aneurysms should continue to be uniformly recommended. Five separate clinical trials studying the effects of β-blockade therapy in patients with Marfan syndrome are analyzed, in addition to four other clinical trials studying the effects of β-blockade therapy in patients without Marfan syndrome. The analysis suggests that the scientific evidence for β-blocker treatment is unconvincing, because β-blockade therapy fails to consistently reduce aortic aneurysm growth in patients with or without Marfan syndrome. It is alarmingly clear that prospective, multicenter clinical trials are greatly needed to test the efficacy of this now conventional therapy in a more robust scientific fashion.
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References
- 1 Johnston KW, Rutherford RB, Tilson MD. , et al. Suggested standards for reporting on arterial aneurysms. J Vasc Surg 1991; 13: 445-450
- 2 National Center for Health Statistics. Deaths, percent of total deaths, and death rates for the 15 leading causes of death: United States and each state, 2000. Hyattsville, MD: National Vital Statistics Systems; 2001
- 3 Upchurch GR, Schaub TA. Abdominal aortic aneurysm. Am Acad Fam Phys 2006; 73: 1198-1204
- 4 Dietz HC, Pyeritz RE. Mutations in the human gene for fibrillin-1 (FBN1) in the Marfan syndrome and related disorders. Hum Mol Genet 1995; 4: 1799-1809
- 5 Silverman DI, Burton KJ, Gray J. , et al. Life expectancy in the Marfan syndrome. Am J Cardiol 1995; 75: 157-160 . 10.1016/S0002–9149(00)80066–1
- 6 Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File 1979–1998 and Compressed Mortality File 1989–1998 on CDC WONDER Online Database, compiled from Compressed Mortality File 2000 Series 20 No. 2A and 2003 Series 20 No. 2E.
- 7 Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File 1999–2006 on CDC WONDER Online Database, compiled from Compressed Mortality File 2009 Series 20 No. 2L.
- 8 Shores J, Berger KR, Murphy EA. , et al. Progression of aortic dilation and the benefit of long-term beta-adrenergic blockade in Marfan's syndrome. N Engl J Med 1994; 330: 1335-1341 . 10.1056/NEJM199405123301902
- 9 Salim MA, Alpert BS, Ward JC. , et al. Effect of beta-adrenergic blockade on aortic root rate of dilation in the Marfan syndrome. Am J Cardiol 1994; 74: 629-633 . 10.1016/0002–9149(94)90762–5
- 10 Danyi P, Elefteriades JA, Jovin IS. Medical therapy of thoracic aortic aneurysms: Are we there yet?. Circulation 2012; 124: 1469-1476
- 11 Matt P, Habashi J, Carrel T. , et al. Recent advances in understanding Marfan syndrome: Should we now treat surgical patients with losartan?. J Thorac Cardiovasc Surg 2008; 135: 389-394 . 10.1016/j.jtcvs.2007.08.047
- 12 U.S. Food and Drug Administration. How drugs are developed and approved. U.S. Food and Drug Administration website. Available at: http://www.fda.gov/drugs/developmentapprovalprocess/howdrugsaredevelopedandapproved/default.htm . Accessed April 1, 2013.
- 13 Gersony DR, McClaughlin MA, Jin Z. , et al. The effect of beta-blocker therapy on clinical outcome in patients with Marfan's syndrome: A meta-analysis. Int J Cardiol 2007; 114: 303-308 . 10.1016/j.ijcard.2005.11.116
- 14 Roman MJ, Rosen SE, Kramer-Fox R. , et al. Prognostic significance of the pattern of aortic root dilation in the Marfan's syndrome. J Am Coll Cardiol 1993; 22: 1470-1476 . 10.1016/0735–1097(93)90559-J
- 15 Legget ME, Unger TA, O'Sullivan CK. , et al. Aortic root complications in Marfan's syndrome: Identification of a lower risk group. Heart 1994; 75: 389-395
- 16 Ladouceur M, Fermanian C, Lupoglazoff JM. , et al. Effect of beta-blockade on ascending aortic dilation in children with the Marfan syndrome. Am J Cardiol 2007; 99: 406-409 . 10.1016/j.amjcard.2006.08.048
- 17 Selamet Tierney ES, Feingold B, Printz BF. , et al. Beta-blocker therapy does not alter the rate of aortic root dilation in pediatric patients with Marfan syndrome. J Pediatr 2007; 150: 77-82 . 10.1016/j.jpeds.2006.09.003
- 18 Propranolol Aneurysm Trial Investigators. Propranolol for small abdominal aortic aneurysms: Results of a randomized trial. J Vasc Surg 2002; 35: 72-79 . 10.1067/mva.2002.121308
- 19 Wilmink ABM, Hubbard CSFF, Day NE. , et al. Effect of propranolol on the expansion of abdominal aortic aneurysms: A randomized study. Br J Surg 2000; 87: 499
- 20 Leach SD, Toole AL, Stern H. , et al. Effect of beta-adrenergic blockade on the growth rate of abdominal aortic aneurysms. Arch Surg 1988; 123: 606-609 . 10.1001/archsurg.1988.01400290092015
- 21 Gadowski GR, Pilcher DB, Ricci MA. Abdominal aortic aneurysm expansion rate: Effect of size and beta-adrenergic blockade. J Vasc Surg 1994; 19: 727-731 . 10.1016/S0741–5214(94)70048–6
- 22 Elefteriades JA, Farkas EA. Thoracic aortic aneurysm: Clinically pertinent controversies and uncertainties. J Am Coll Cardiol 2010; 55: 841-857 . 10.1016/j.jacc.2009.08.084
- 23 Hiratzka LF, Bakris GL, Beckman JA. , et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J Am Coll Cardiol 2010; 55: e27-e129