Sakakibara Heart Institute of Okayama, Okayama, Japan.
J Am Coll Cardiol. 2010 Mar 9;55(10):976-82. doi: 10.1016/j.jacc.2009.09.062.
The aim of this study was to evaluate the impact of olmesartan on progression of coronary atherosclerosis.
Prior intravascular ultrasound (IVUS) trial results suggest slowing of coronary atheroma progression with some medicines but have not shown convincing evidence of regression with angiotension-II receptor blocking agents.
A prospective, randomized, multicenter trial-OLIVUS (Impact of OLmesartan on progression of coronary atherosclerosis: evaluation by IntraVascular UltraSound)-was performed in 247 stable angina pectoris patients with native coronary artery disease. When these patients underwent percutaneous coronary intervention for culprit lesions, IVUS was performed in their nonculprit vessels (without angiographically documented coronary stenosis [<50%]). Patients were randomly assigned to receive 10 to 40 mg of olmesartan or control and treated with a combination of beta-blockers, calcium channel blockers, diuretics, nitrates, glycemic control agents, and/or statins per physician's guidance. Serial IVUS examinations (baseline and 14-month follow-up) were performed to assess coronary atheroma volume. Volumetric IVUS analyses included lumen, plaque, vessel volume, percent atheroma volume (PAV), percent change in total atheroma volume (TAV) and PAV.
Patient characteristics and blood pressure control were identical between the 2 groups. However, follow-up IVUS showed significantly decreased TAV and percent change in PAV in the olmesartan group (5.4% vs. 0.6 % for TAV and 3.1% vs. -0.7% for percent change in PAV, control vs. olmesartan, p < 0.05 for all).
These observations suggest a positive role in a potentially lower rate of coronary atheroma progression through the administration of olmesartan, an angiotension-II receptor blocking agent, for patients with stable angina pectoris.
本研究旨在评估奥美沙坦对冠状动脉粥样硬化进展的影响。
先前的血管内超声（IVUS）试验结果表明，某些药物可减缓冠状动脉粥样硬化进展，但尚未证明血管紧张素-II 受体阻滞剂可令人信服地逆转动脉粥样硬化。
一项前瞻性、随机、多中心试验-OLIVUS（奥美沙坦对冠状动脉粥样硬化进展的影响：血管内超声评估）-在 247 例稳定性心绞痛伴原发性冠状动脉疾病的患者中进行。当这些患者因罪犯病变而行经皮冠状动脉介入治疗时，对其非罪犯血管（无血管造影证实的冠状动脉狭窄 [<50%]）进行 IVUS 检查。患者被随机分配接受 10 至 40 毫克奥美沙坦或对照治疗，并根据医生的指导接受β受体阻滞剂、钙通道阻滞剂、利尿剂、硝酸盐、血糖控制药物和/或他汀类药物的联合治疗。进行连续 IVUS 检查（基线和 14 个月随访）以评估冠状动脉粥样斑块体积。体积 IVUS 分析包括管腔、斑块、血管体积、粥样斑块体积百分比（PAV）、总粥样斑块体积变化百分比（TAV）和 PAV。
两组患者的特征和血压控制均相同。然而，随访 IVUS 显示奥美沙坦组的 TAV 和 PAV 变化百分比显著降低（TAV 为 5.4%比 0.6%，PAV 为 3.1%比-0.7%，对照组与奥美沙坦组相比，所有均<0.05）。
这些观察结果表明，对于稳定性心绞痛患者，给予奥美沙坦（一种血管紧张素-II 受体阻滞剂）可能会降低冠状动脉粥样硬化进展的速度，从而发挥积极作用。
