| Summary: | 碩士 === 高雄醫學大學 === 藥學系臨床藥學碩士班 === 102 === Background: Aortic diseases can divide as aortic dissection and aortic aneurysm, and the mortality is high in elderly when the rupture occurs. Present studies have confirmed that the probability of aortic rupture is associated with aortic diameter. However, there is no medication proven to reduce the growth rate of aortic diameter. Recently, several studies suggest that some medication can prove beneficial of aortic diseases not because of their ability to reduce blood pressure and lipid profile, including statin, angiotensin-converting enzyme inhibitor (ACEI), angiotensin II receptor blocker (ARB), ??-blocker, and calcium channel blocker (CCB). Besides, safety of antiplatelets for aortic diseases is still controversial.
Aim and objectives: In this study, we design a systematic review and meta-analysis to evaluate the effectiveness of statin, ACEI, ARB, ??-blocker, CCB and antiplatelets in aortic diseases population, and conduct a retrospective cohort study at a medical center in southern Taiwan to obtain local information of type B aortic dissection (TBAD), finally compare the results from each other.
Methods: The study is divided into two parts. The first part is a systematic review and meta-analysis to conduct the clinical effect of medication for aortic disease patients. The search process will continue until June 2014. Study endpoints include death, surgery repair, aortic events and expansion rate of aortic diameter. The second part is a retrospective cohort study. We plan to review the hospital records of TBAD population at a medical center in Southern Taiwan from January 2008 to June 2013, and assess baseline characristics, disease information, prescribing pattern, event rate, and clinical effect of medication. Index date defined as first TBAD diagnosis date.
Results and discussion: The systematic review and meta-analysis identified a total of 19 cohort studies, 3 studies for TBAD, 3 studies for thoracic aortic aneurysm (TAA), and 14 studies for abdominal aortic aneurysm (AAA). The results of TBAD showed that CCB significantly decrease all-cause mortality (odd ratio [OR]=0.55, 95% confidence interval [CI]: 0.35~0.88). The results of TAA showed that statin significantly decrease the events of surgery repair (OR=0.50, 95% CI: 0.38~0.67) and the events attributed to aortic diseases (OR=0.53, 95% CI: 0.40~0.69), and antiplatelets significantly increase the events attributed to aortic diseases (OR=1.69, 95% CI: 1.13~2.52). The results of AAA showed that statin (mean difference=-1.50, 95% CI -2.36~-0.64) and ARB (mean difference=-0.91, 95% CI: -1.78~-0.03) significantly decrease the expansion rate of aortic diameter. We included 106 patients in the hospital-based cohort study and the mean follow-up period was 2.75 years. The most common comorbidities were hypertension, followed by dyslipidemia and diabetic mellitus. Study endpoints mostly occurred within 6 months after index date. About 80% patients continued using two or more antihypertensive drugs, and no significant effect among different groups based on number of antihypertensive drugs and ACEI/ARB use or not. Besides, antiplatelet user, which defined as cumulative daily dose of antiplatelets more than 28 units, significantly increase the events of surgery repair or death (adjusted HR [aHR]= 4.14, 95% CI: 1.03~16.66) and all-cause mortality (aHR= 6.06, 95% CI: 1.18~31.16).
Conclusion: The systematic review and meta-analysis showed that statin and ARB beneficial for aortic aneurysm population, but antiplatelets increase the risk of TAA population. All the included studies were observational studies and nearly half were low quality, so further prospective studies might be required to determine the effect. The cohort study showed that antiplatelets increased the risk of surgery repair or death in TBAD population. Further study can investigate whether dose relationship or not of antiplatelets.
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