Sometimes medical researchers make good discoveries about one area of medicine when they are studying another. This is what happened when research on how well aliskiren slowed or reversed coronary artery disease turned up unexpected results. They are published in the September issue of The Journal of the American Medical Association.
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Though aliskiren didn’t significantly reduce atherosclerosis (clogging of the arteries), researchers did find that patients who took it had a lower risk of sudden death, stroke and heart attack.
Initial focus of study
The AQUARIUS trial originally set out to determine how well aliskiren reduced the progression of coronary artery disease. Aliskiren is a renin inhibitor and renin is a hormone that plays a role in raising your blood pressure.
Participants in the Cleveland Clinic Coordinating Center for Clinical Research (C5Research) study had existing coronary artery disease and stabilized high blood pressure.
Aliskiren had some success in further lowering patients’ blood pressure, but it didn’t definitively improve artery health. Stephen J. Nicholls, MD, PhD, senior consultant to C5Research, says, “Our primary endpoint – a decrease in the volume of disease in the artery – did not meet statistical significance.”
Other results found
Although researchers didn’t find what they were looking for (a significant reduction in the volume of coronary artery disease), they did find a 50 percent decrease in the incidence of sudden death, stroke and heart attack in patients who took aliskiren compared to those who did not receive the drug.
The results suggest that patients with existing heart disease and borderline blood pressure levels (less than 140 systolic) could benefit by having their blood pressure lowered even further than current guidelines suggest.
Steven Nissen, MD, chairman of the AQUARIUS trial executive committee and chairman of Cleveland Clinic’s Robert and Suzanne Tomsich Department of Cardiovascular Medicine, says that these findings are encouraging. However, he adds, “We have to be cautious interpreting our results on cardiovascular events because this trial was not formally designed to look at these outcomes.”
The coincidental nature of the findings doesn’t lessen their significance, though, or their potential for future impact on care. Dr. Nissen says, “The data indicate that renin inhibition is safe in patients who have coronary artery disease and have their blood pressure under control, and it may have some beneficial cardiovascular effects.”