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Legrand M, Futier E, Leone M, Deniau B, Mebazaa A, Plaud B, Coriat P, Rossignol P, Vicaut E, Gayat E. Impact of renin-angiotensin system inhibitors continuation versus discontinuation on outcome after major surgery: protocol of a multicenter randomized, controlled trial (STOP-or-NOT trial). Trials 2019; 20:160. [PMID: 30836981 PMCID: PMC6402139 DOI: 10.1186/s13063-019-3247-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 02/12/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Chronic treatment of hypertension or heart failure very often includes an angiotensin-converting enzyme inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) as renin-angiotensin system inhibitors (RASi) treatments. To stop or not to stop these medications before major surgery remains an unresolved issue. The lack of evidence leads to conflicting guidelines with respect to RASi management before major surgery. The purpose of this study is to evaluate the impact of a strategy of RASi continuation or discontinuation on perioperative complications in patients undergoing major non-cardiac surgery. METHODS This is a multicenter, open-labeled randomized controlled trial in > 30 French centers. In the experimental group, RASi will be continued while the treatment will be stopped 48 h before the surgery in the control arm. The primary endpoint is a composite endpoint of major complications after surgery. An endpoint adjudication committee will review clinical data and adjudicate efficacy endpoints while blinded to the assigned study drug group. Main analysis will be by intention-to-treat comparing the composite outcome measure at 28 days in the two groups. A total of 2222 patients are planned to detect an absolute complications difference of 5%. DISCUSSION The results of the trial should provide robust evidence to anesthesiologists and surgeons regarding management of RASi before major non-cardiac surgery. TRIAL REGISTRATION ClinicalTrials.gov, NCT03374449 . Registered on 11 December 2017.
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Affiliation(s)
- Matthieu Legrand
- AP-HP, GH St-Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, St-Louis Hospital, Assistance Publique-Hopitaux de Paris, Paris, France. .,University Paris Diderot, Paris, France. .,UMR INSERM 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, Paris, France. .,F-CRIN INI-CRCT network, Nancy, France.
| | - Emmanuel Futier
- Département de Médecine Périopératoire, Anesthésie Réanimation Hôpital Estaing, CHU Clermont-Ferrand & Université Clermont Auvergne, CNRS, Inserm, Clermont-Ferrand, France
| | - Marc Leone
- Service d'Anesthésie et de Réanimation, Hôpital Nord, Aix Marseille Université, APHM, Marseille, France
| | - Benjamin Deniau
- AP-HP, GH St-Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, St-Louis Hospital, Assistance Publique-Hopitaux de Paris, Paris, France.,University Paris Diderot, Paris, France.,UMR INSERM 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, Paris, France
| | - Alexandre Mebazaa
- AP-HP, GH St-Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, St-Louis Hospital, Assistance Publique-Hopitaux de Paris, Paris, France.,University Paris Diderot, Paris, France.,UMR INSERM 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, Paris, France.,F-CRIN INI-CRCT network, Nancy, France
| | - Benoît Plaud
- AP-HP, GH St-Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, St-Louis Hospital, Assistance Publique-Hopitaux de Paris, Paris, France.,University Paris Diderot, Paris, France.,UMR INSERM 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, Paris, France
| | - Pierre Coriat
- Département d'Anesthésie-Réanimation, La Pité-Salpétrière, Université Paris Descartes, Paris, France
| | - Patrick Rossignol
- F-CRIN INI-CRCT network, Nancy, France.,Inserm, Centre d'Investigations Cliniques-Plurithématique 14-33, Inserm U1116, CHRU Nancy, Université de Lorraine, Nancy, France
| | - Eric Vicaut
- Unité de recherche Clinique, GH St-Louis-Lariboisère-Fernand Widal, Université Paris Diderot, Paris, France
| | - Etienne Gayat
- AP-HP, GH St-Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, St-Louis Hospital, Assistance Publique-Hopitaux de Paris, Paris, France.,University Paris Diderot, Paris, France.,UMR INSERM 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière Hospital, Paris, France.,F-CRIN INI-CRCT network, Nancy, France
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Fluvastatin combined with benazepril may contribute to the favorable prognosis of patients with atrial fibrillation. Biomed Pharmacother 2016; 83:687-692. [PMID: 27470569 DOI: 10.1016/j.biopha.2016.07.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/01/2016] [Accepted: 07/18/2016] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to observe the clinical efficacy of fluvastatin combined with benazepril in the treatment of patients with atrial fibrillation (AF). A total of 92 patients with AF were randomly assigned to the case group (n=46), in which the patients were treated with fluvastatin (80mg) plus benazepril (10mg), or to the control group (n=46), in which the patients were treated with fluvastatin (80mg). The conversion rate of sinus rhythm was higher in the case group than in the control group (P<0.05). The case group had more treatment-effective patients than the control group, with fewer treatment-ineffective patients (P<0.05). The LVEDd, LVESd, LAD, and LVEF indexes in the case group were lower than in the control group after 6 months of treatment (all P<0.05). Levels of hs-CRP were also lower in patients in the case group than in patients in the control group after 1 month of treatment (P<0.05). After 12 months, renin and Ang II concentrations were lower in patients in the case group than in the control group (both P<0.05). Significant differences in IL-6 and TNF-α expression were found between the two groups after 1 month, 6 months, and 12 months of treatment (all P<0.05). Compared to patients in the control group, the levels of total cholesterol (TC), triglycerides, and LDL-C in the case group were lower after 6 and 12 months of treatment (all P<0.05), while the HDL level was higher (P<0.05). Treatment with fluvastatin combined with benazepril further increased the conversion rate of sinus rhythm and significantly improved the quality of life and prognosis of AF patients.
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Gungor B, Ekmekci A, Arman A, Ozcan KS, Ucer E, Alper AT, Calik N, Yilmaz H, Tezel T, Coker A, Bolca O. Assessment of interleukin-1 gene cluster polymorphisms in lone atrial fibrillation: new insight into the role of inflammation in atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:1220-7. [PMID: 23713812 DOI: 10.1111/pace.12182] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 03/12/2013] [Accepted: 04/02/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Systemic inflammation is accepted as one of the pathophysiological mechanisms of atrial fibrillation (AF). The role of inflammation has been shown previously. Interleukin (IL) system is the main modulator of the inflammatory responses and genetic polymorphisms of IL-1 cluster genes are associated with increased risk for inflammatory diseases. OBJECTIVES To investigate the association between polymorphisms of IL-1 cluster genes and lone AF. SUBJECTS AND METHODS DNA samples were collected from 70 proven lone AF patients and 70 healthy subjects. Genomic DNA was typed for the variable number of the tandem repeat (VNTR) IL-1 receptor antagonist (RN) gene polymorphism, IL-1B -511 C > T(rs16944) promoter polymorphism, and +3953 C > T(rs1143634) polymorphism in exon 5 by polymerase chain reaction. RESULTS In lone AF group the frequency of IL-1RN2/2 and IL-1RN1/2 genotypes were higher than in the control group (7.2% vs 4.3% and 48.5% vs 22.8%, respectively; χ(2) = 14.1; P = 0.028). The frequency of allele 2 was significantly higher in the lone AF group (32.1% vs 15.7%; χ(2) = 10.7; P = 0.005). Allele and genotype distribution of IL-1B -511 C > T and +3953 C > T polymorphisms were not statistically different between the groups. C-reactive protein (CRP) levels were higher in lone AF patients compared to the control group (median = 1.25, interquartile range [IQR] = 0.85 vs median = 1.08, IQR 0.46 mg/L, respectively; P = 0.02). In multivariate regression analysis, presence of allele 2 of IL-1 VNTR polymorphism and elevated plasma high-sensitive-CRP levels were the independent predictors of lone AF. CONCLUSION Presence of allele 2 of VNTR polymorphism of IL-1RN gene may cause increased risk for lone AF probably due to the inadequate limitation of inflammatory reactions.
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Affiliation(s)
- Baris Gungor
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
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Myburgh R, Hochfeld WE, Dodgen TM, Ker J, Pepper MS. Cardiovascular pharmacogenetics. Pharmacol Ther 2011; 133:280-90. [PMID: 22123178 DOI: 10.1016/j.pharmthera.2011.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 11/04/2011] [Indexed: 12/25/2022]
Abstract
Human genetic variation in the form of single nucleotide polymorphisms as well as more complex structural variations such as insertions, deletions and copy number variants, is partially responsible for the clinical variation seen in response to pharmacotherapeutic drugs. This affects the likelihood of experiencing adverse drug reactions and also of achieving therapeutic success. In this paper, we review key studies in cardiovascular pharmacogenetics that reveal genetic variations underlying the outcomes of drug treatment in cardiovascular disease. Examples of genetic associations with drug efficacy and toxicity are described, including the roles of genetic variability in pharmacokinetics (e.g. drug metabolizing enzymes) and pharmacodynamics (e.g. drug targets). These findings have functional implications that could lead to the development of genetic tests aimed at minimizing drug toxicity and optimizing drug efficacy in cardiovascular medicine.
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Affiliation(s)
- Renier Myburgh
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, South Africa
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Lu XM, Chen GJ, Yang Y, Qiu HB. Angiotensin-converting enzyme polymorphism affects outcome of local Chinese with acute lung injury. Respir Med 2011; 105:1485-90. [PMID: 21742477 PMCID: PMC7126786 DOI: 10.1016/j.rmed.2011.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 06/08/2011] [Accepted: 06/20/2011] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Acute Lung Injury (ALI) with genetic predisposition is fatal. Relationship between angiotensin-converting enzyme insertion/deletion (ACE I/D) polymorphism and the prognosis of local Chinese patients with ALI was investigated; meanwhile, the mechanisms involved were explored. METHODS 101 ALI patients, 408 non-ALI patients and 236 healthy blood donors were enrolled. ACE I/D polymorphism was detected by polymerase chain reaction, then ACE genotype (II, ID, DD) and allele (I, D) frequencies were compared. Clinical data of ALI patients was calculated. Also, peripheral blood mononuclear cells (PBMC) were isolated from healthy volunteers with different ACE genotypes. Lipopolysaccharide (LPS)-induced ACE gene mRNA expression and ACE activity was measured. RESULTS There was no significant difference in the frequencies of the genotypes and alleles. Acute Physiology and Chronic Health Evaluation (APACHE) II score was higher in DD subgroup than in II subgroup (19.7 ± 8.7 and 15.6 ± 6.2; P < 0.05). The 28-day mortality was significantly different (17.4%, 26.8%, and 64.3% for II, ID, and DD; P = 0.013). DD genotype was the independent prognostic factor for 28-day outcome. Furthermore, LPS-induced ACE mRNA expression and ACE activity from PBMC in DD genotype subgroup were both significantly higher than those in the other two subgroups. CONCLUSIONS ACE I/D polymorphism is a prognostic factor for ALI. Patients with the DD genotype have higher mortality of ALI. Polymorphism influences the expression of ACE gene in LPS-stimulated PBMC, DD genotype leads to higher level of mRNA and enzyme activity. It may be one of the mechanisms involved.
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Affiliation(s)
- Xiao-Min Lu
- Department of Critical Care Medicine, Nanjing Zhong-Da Hospital, Southeast University School of Medicine, 87 Ding jia Qiao, Nanjing, China
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Zhou TB, Ou C, Qin YH, Su LN, Lei FY, Huang WF, Zhao YJ, Pang YS, Yang KP. Association of angiotensin converting enzyme insertion/deletion gene polymorphism with idiopathic nephrotic syndrome susceptibility in children: a meta-analysis. J Renin Angiotensin Aldosterone Syst 2011; 12:601-10. [PMID: 21946394 DOI: 10.1177/1470320311422578] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background and objective: Angiotensin converting enzyme (ACE) gene contains either an insertion (I) allele or a deletion (D) allele forming three potential genotypes: II, ID and DD. The D allele or DD genotype has been reported to be associated with higher plasma ACE level. An assessment of the association between ACE I/D gene polymorphism and idiopathic nephrotic syndrome (INS) susceptibility in children is still controversial. This meta-analysis was performed to evaluate the association between ACE I/D gene polymorphism and the onset of INS. Method: A predefined literature search and selection of eligible relevant studies were performed to collect data from electronic databases, and eligible investigations were synthesized using the meta-analysis method. Results: Nine investigations were identified for the analysis of association between ACE I/D gene polymorphism and INS risk in children, including six in Asians, one study for Caucasians and two for Africans. There was positive association between D allele or DD genotype and INS susceptibility in Asians (OR = 1.75, p = 0.01; OR = 2.01, p = 0.02), but not for Caucasian children and Africans (for Caucasians, D: OR=1.35, p = 0.27, DD: OR = 0.95, p = 0.91; for Africans, D: OR = 1.70, p = 0.56, DD: OR = 1.60, p = 0.73). Furthermore, II homozygous seemed to play a positive role against INS onset for Asians (OR = 0.59, p = 0.02), but the link between II genotype and INS risk was not observed in Caucasian children and Africans (Caucasians: OR = 0.31, p = 0.06; Africans: OR = 0.50, p = 0.59). Conclusions: D allele and DD homozygous might become significant genetic molecular markers for INS susceptibility in Asian children, but the association was not observed in Caucasians or Africans. However, the conclusion from our study cannot be sustained and more investigations on larger sample in different populations are required to further clarify the role of D allele or DD homozygous in the onset of INS in difference races.
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Affiliation(s)
- Tian-Biao Zhou
- Department of Pediatrics, The First Affiliated Hospital of GuangXi Medical University, NanNing, China
| | - Chao Ou
- Department of Experimental Pathology, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Yuan-Han Qin
- Department of Pediatrics, The First Affiliated Hospital of GuangXi Medical University, NanNing, China
| | - Li-Na Su
- Department of Pediatrics, The First Affiliated Hospital of GuangXi Medical University, NanNing, China
| | - Feng-Ying Lei
- Department of Pediatrics, The First Affiliated Hospital of GuangXi Medical University, NanNing, China
| | - Wei-Fang Huang
- Department of Pediatrics, The First Affiliated Hospital of GuangXi Medical University, NanNing, China
| | - Yan-Jun Zhao
- Department of Pediatrics, The First Affiliated Hospital of GuangXi Medical University, NanNing, China
| | - Yu-Sheng Pang
- Department of Pediatrics, The First Affiliated Hospital of GuangXi Medical University, NanNing, China
| | - Kun-Peng Yang
- Department of Internal Medicine, Township Health Centers of ShilLing in LongQuan district, ChengDu, China
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Lemmens R, Hermans S, Nuyens D, Thijs V. Genetics of atrial fibrillation and possible implications for ischemic stroke. Stroke Res Treat 2011; 2011:208694. [PMID: 21822468 PMCID: PMC3148589 DOI: 10.4061/2011/208694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 05/25/2011] [Accepted: 05/31/2011] [Indexed: 12/19/2022] Open
Abstract
Atrial fibrillation is the most common cardiac arrhythmia mainly caused by valvular, ischemic, hypertensive, and myopathic heart disease. Atrial fibrillation can occur in families suggesting a genetic background especially in younger subjects. Additionally recent studies have identified common genetic variants to be associated with atrial fibrillation in the general population. This cardiac arrhythmia has important public health implications because of its main complications: congestive heart failure and ischemic stroke. Since atrial fibrillation can result in ischemic stroke, one might assume that genetic determinants of this cardiac arrhythmia are also implicated in cerebrovascular disease. Ischemic stroke is a multifactorial, complex disease where multiple environmental and genetic factors interact. Whether genetic variants associated with a risk factor for ischemic stroke also increase the risk of a particular vascular endpoint still needs to be confirmed in many cases. Here we review the current knowledge on the genetic background of atrial fibrillation and the consequences for cerebrovascular disease.
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Affiliation(s)
- Robin Lemmens
- Department of Neurology and Laboratory for Neurobiology, Section of Experimental Neurology, School of Medicine, University of Leuven, Herestraat 49, 3000 Leuven, Belgium
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