Abstract
BackgroundAortic root dissection is the leading cause of death in Marfan syndrome. Beta-adrenergic blockers have been proposed as a preferred agent in Marfan syndrome to reduce aortic complications. Losartan has also shown beneficial effects in reduction of aortic root dilation in animal models and a few small studies. But it is not clear whether losartan could provide more benefit to patients with Marfan syndrome. A few studies have been done with head to head comparison between the two with conflicting results. We aimed to perform a meta-analysis of all randomized controlled trials (RCTs) that compared the role of atenolol and losartan in patients with Marfan syndrome.MethodsWe searched PubMed, EMBASE, Cochrane CENTRAL, Scopus and relevant references for RCTs (inception through May 15, 2016 for English language only) and performed meta-analysis using random effects model. Rate of change in the growth of aortic root and ascending aorta, rate of change in aortic-root Z score (maximal aortic root area indexed to body surface area), aortic complications and adverse events were the measured outcomes.ResultsFour randomized controlled trials with a total population of 698 (349 in each arm) comprising of children and young adults were analyzed. There was no significant difference in mean change in aortic root dilation between two arms [Weighted Mean Difference (WMD) 0.36 cm (-0.74 to 1.45); p=0.52]. No difference in change in mean ascending aortic diameter was observed between the groups [WMD 0.37cm (-0.67 to 1.41); p=0.49). Only two of the included studies reported on aortic-root Z score which didn’t show any difference between the groups [WMD 1.10 (-1.57 to 3.77); p=0.42]. There was no difference in the rate of aortic complications between two arms at the end of follow up [Hazard ratio 0.87 (0.12-6.16); p=0.89]. Other adverse outcomes were similar between two groups.ConclusionWithout any differences in the effect of atenolol and losartan on the changes in aortic growth rate, our meta-analysis found no advantage of one agent over other. No difference was observed in the rate of aortic complications between the groups.