This article is more than 5 years old. Information may no longer be current.

ALPINE: Atherosclerosis progression increased with renin inhibition

Add topic to email alerts

Receive an email when new articles are posted on

Please provide your email address to receive an email when new articles are posted on .

Subscribe

Added to email alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

Back to Healio

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

Back to Healio

MRI quantification demonstrated that renin inhibition with aliskiren resulted in an “unexpected” increase in aortic atherosclerosis as compared with placebo in high-risk patients with CVD.

The single-center, randomized, double blind, placebo-controlled ALPINE study included 71 patients with pre-existing CVD (mean age, 64 years). Researchers studied whether renin inhibition with aliskiren (Tekturna, Novartis) would prevent progression of atherosclerosis, as measured by high-resolution MRI of arterial wall volume in the thoracic and abdominal aortas.

Patients were randomly assigned 150 mg aliskiren (n=34) or placebo (n=37) after a 2-week, single blind, placebo phase. After 2 weeks, treatment dose was escalated to 300 mg and maintained during the remainder of the study. MRI assessment of atherosclerotic plaque in the thoracic and abdominal segments was performed at baseline and at study completion or termination (up to 36 weeks).

 

Sanjay Rajagopalan

Sanjay Rajagopalan, MD, of the Dorothy M. Davis Heart and Lung Research Institute in Columbus, Ohio, presented results at the American Society of Hypertension Annual Scientific Meeting. Aliskiren use was associated with significant progression of aortic wall volume (normalized total wall volume: 5.31 mm³ vs. 0.15 mm³; P=.03) and percentage wall volume (3.37% vs. 2.02%; P=.04) as compared with placebo.

Researchers also studied the effect of ACE inhibitor/angiotensin receptor blocker therapy on changes in MRI endpoints. Subgroup analysis revealed atherosclerosis progression only in the aliskiren group.

The data were simultaneously published in the Journal of the American Heart Association.

“Although preliminary, these results may have implications for the use of renin inhibition as a therapeutic strategy in patients with CVD, especially in those receiving ACE inhibitor/angiotensin receptor blocker therapy,” the ALPINE researchers wrote in JAHA.

In December 2011, the study was terminated by the sponsor after results from the ALTITUDE trial were made public. Results revealed a 7% increase in major adverse CV and renal events with aliskiren, driven by a 25% increase in stroke rate and resuscitated sudden death. ALPINE participants were required to attend a termination visit that included repeat MRI.

“The ongoing AQUARIUS trial, which will evaluate the effect of aliskiren on progression of atherosclerosis in patients with established coronary disease on intravascular ultrasound endpoints, is likely to provide additional information,” according to the researchers.

For more information:

Mihai G. J Am Heart Assoc. 2013;doi:10.1161/JAHA.112.004879.

Rajagopalan S. LB-PO-08. Presented at: American Society of Hypertension Annual Scientific Meeting; May 15-18, 2013; San Francisco.

Disclosure: The study was funded by Novartis. The researchers report no relevant financial disclosures.