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Aortic Aneurysm - Losartan study on mice shown to reverse size of aneur...
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Aortic Aneurysm - Losartan study on mice shown to reverse size of aneurysms???

Hi. I have two questions:

1) Do I need surgery soon?

I have recently been diagnosed with an aneurysm of my aortic root of 4.8cm and also my ascending aorta of 4.9cm. My aortic valve is trileaflet and still in good shape. My ascending aorta is 1.9 x the diameter of my descending aorta.

- I'm a 41 year old male
- 6'2" and 210 Lbs.
- I'm athletic (or I was before my diagnois)
- I do NOT have marfans syndrome, but apparently a connective tissue disorder.
- I have a history of "massive heart attacks" on my mothers side (no autopsies were done)
- I feel fine. If it wasn't for the CT scan findings I would not realize there is an issue.


2) Cozaar/Losartan: Is there a chance that I can avoid surgery by taking Cozaar. If so, how much should I take each day?

I just read about a study on mice with marfan syndrome. Apparently, their aneurismal aorta
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Avatar_n_tn
Hi shidaddy,

You and I are in somewhat similar situations. I'm 6'1", 190 lbs, used to be athletic before my diagnosis, not quite Marfan but some type of milder connective tissue problem, 3.8 cm aortic root, tricuspid aortic valve (we are fortunate that we do not have bicuspids!). Kind of throws a cramp in your style, doesn't it?

I came back from my cardiologist appt 6 months back with some more aortic growth, as usual. I was disappointed and said a prayer to the Lord Jesus Christ - and a day or two later, I got an email from the National Marfan Foundation regarding the losartan studies. Wow, what a direct answer.

I called my doc up and he prescribed me not Losartan but valsartan, which is a similar drug. He put me on a very light dose (80 mg/day), about half of what someone my body size would be taking in Dr. Dietz' study on adolescents this fall.

Fast forward 6 months - I had my follow-up echo last Monday. Thank the Lord - no growth. All my numbers were "identical to last time," according to my cardio. That is unusual because my aorta had been growing up until then. We cranked up the dosage to 160mg/day, which is more in line with what someone my size should be taking. I'm praying that at my next echo, the aorta will have shrunk. Who knows? I'm just happy for now.

I've spoken with other people taking losartan, and they also have stabilized their aortic roots. One lady I know was taking a pretty high dosage (300 mg of Avapro/irbesartan per day, the max you should take for that drug) and her aorta shrunk from 4.2 cm to 3.7 cm over a 6-mo. period.

None of that answers your question directly, but there is indirect, un-official basis for having a lot of hope for these studies. Talk to your cardiologist and see if he or she will prescribe some for you at a *HIGH* dosage. You're almost at the threshold for surgery, so tread carefully. I'll pray you experience the same kind of (seeming) success as me, if not better!

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PS - the surgery IS scary, but if done by an experienced surgeon, the success rate is extraordinarily high, and the life expectancy is basically normal. Many of the post-operative deaths you hear about are folks that are already dissecting/rupturing, the elderly, or those already in some sort of bad heart shape. If you're generally healthy and you go to a good surgeon, there is nothing to fear!
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Avatar_m_tn
Hope the drug works for you. I had a 5.0 cm aneurysm of the ascending aorta, very similar to yours, normal valve, only the ascending aorta, etc. I'm male, 48, 160 lbs, athletic, non-Marfan's. I had surgery in early '04. I was back on my bicycle in 6 weeks, it took about 6 months for me to feel really recovered, and a year before my sleep was back to normal. Today, I ride about 160 miles per week at a fairly high intensity level (I used to race competitively). The only thing I don't do is lift very heavy weights. Otherwise, no problems. I take a low dose (75 mg daily) of metoprolol, a beta blocker. It cuts my aerobic capacity by about 10%, you get used to it.

If you do get to where you need surgery, make certain you go with a highly experienced surgeon who has done hundreds of aortic repairs. Cleveland Clinc has a great reputation. I had my surgery done by Dr. Vincent Gaudiani in California, he's done hundreds of such operations. I had a mini-sternotomy (only 4" near-invisible scar), and was on pump for only 25 minutes. Don't get someone who has only done a few of these!
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Avatar_n_tn
i'm in the exact same situation as shiddady and nick.  I'm 44,, 6', 220 lbs, my aortic root is ~4.3cm and I'm on 80 mg of valsartan.  The interesting part was that a year ago my aortic root was measured at 4.8 by echo and I was talking to surgeons.

We did an MRI and it measured 4.2. The echo has about a .2 margin for error.  An echo last week measured the aortic root at about 4.3 or 4.4.  My point is to get an MRI to baseline it first and then once every year or two just to check it.

I watched it grow .2 about every two years since it '92, it was 3.9 then.  Don't worry about about a .1 or .2 change it's not that accurate.

I'm also hoping to see it shrink but who knows. I figure I have 7 to 10 years to see but who knows about that too.  

not sure if you'll read this since you posted a year ago.
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Avatar_n_tn
hi, all
i have Aortic Aneurysm about. 6.cm
any drug or Losartan  can help me
thanks
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Avatar_n_tn
Glad I found this.

41 years old.
6' 1"
Went from 200lbs to 280 pounds since dialaiton was found (5 year timeframe).
Was an avid cyclist (competitive) until this happened then I became depressed and quit doing much of anything.  No longer depressed and have hired a personal trainer.  Down to 260.....  worried though because it is mostly weights.

Dilation found by chance about 5 years ago.  Valve is fine.  Any surgery would spare valve.   Remained stable at 4.1 CM measured yearly until last year when it grew to 4.6 (worried because that is the period after beginning weight training).  We now measure it every six months, the first of which will be this friday.

In the meantime my doc put me on cozaar 50mg 6 months ago.   We shall see what happened because measurment and doc appointment happen at same time this friday.  I'm scared to death because my gut says surgery is in my future.
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Avatar_n_tn
Should I be worried or am I making something of nothing?
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Avatar_f_tn
Not here to scare anyone, but my aunts friend just died of this.  They told her she did not need surgery and then it ruptured.  She was however like 60 something and a big time smoker and drinker.  I am sure this played a key factor into hers rupturing.  I just wanted to put this out there and I know some will be upset.  And I am sorry....
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690060_tn?1247845341
I think that's valuable info, Crystal. Keep up the good work.
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Avatar_n_tn
What was the size of your Aunts friends dilation and was it on the aortic root.....  

ie do you really know enough about this persons condition to know we are talking apples to apples?  I know very little about my Aunts friends medical conditions or causes of death.

I appreciate the sentiment, but do you really know enough about the situaiton to provide added value here (maybe you do.... just asking).
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Avatar_n_tn
What were your measurements this last appointment?  I hope it went okay.  
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Hey all,
Interesting stuff.  I want to thank whoever it was out there that first posted about Cozaar, Losartan, and valsartan it all sounds promising.

My name is Steve and I am a 34 year old male.  I was diagnosed at birth with a bicuspid valve.  I have never had any symptoms with this and have always had an active normal live.  6'2" 180lbs.  
Last summer I decided to get a CT done since I hadn't in over 10 years.  Well I wish I would have done it sooner as my ct discovered an aneurysm of my ascending aorta of 4.9 cm.  I was put on 50mg metoprolol daily but nothing else.  I have had 2 ct's done since last July and I am still stable at 4.9 cm.  I am encouraged about these drugs that may slow the growth or reverse it of the aneurysm as I would probably be able to avoid surgery until my valve possibly needed to replaced in my 50's or 60's.  
I am going to contact my surgeon and cardiologist as soon as I can to see about getting put on one of these other drugs possibly.
Thanks again and best of luck to us all.
Keep the faith,
Steve
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Avatar_n_tn
Hello:
This is all so overwhelming, isn't it? I am a 42 year old with a 4.2 aortic aneurysm, and seeing the heart surgeon next week. What kind of questions should I be asking him?  How are you all doing now?  Take care,
Cin
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Of course you are absolutely correct, there is no guarantee that any aneurysm will not rupture. Unlikely or low risk are the terms which doctors usually use, or should, not it will not rupture. My brother in law had his head scanned in November last year because he was suffering headaches. They found nothing except a small aneurysm and they put it at low risk. In January this year he suddenly had severe headaches and collapsed, because it ruptured. Yes it shocked the doctors, but it just proves things happen unexpectedly.
They put around 5 or 6 platinum coils into the aneurysm and then stented it. Thankfully he has nearly fully recovered but it was a big scare.
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I haven't posted on this thread in awhile, and since CynNS asked, I will:

since my first post up above, I increased my valsartan dosage up to 320mg/day.  Really, if you are my size or bigger (6' 200lb), you need to be taking the FDA maximum dose or higher (if your doc will prescribe it).  This aneurysm/ARB therapy really is dose dependent.

Anyway, my aortic root shrunk from 3.9cm to 3.7cm (ie, "normal") and has remained stable there for several years now!

Thank the Lord.
Nick
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Do trials show that once the medication is stopped that the aorta remains the correct size? or is it too early to tell yet?
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We don't know, but it is strongly suspected that this medication must be taken for life.  If you stop, it will probably grow again.


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QUOTE "Anyway, my aortic root shrunk from 3.9cm to 3.7cm (ie, "normal") and has remained stable there for several years now!"

Has  a study with patients concluded that valsartan is effective in preventing the progression of AA.  "Overall, the present study demonstrated that treatment with valsartan, significantly prevented of AAA?  There are positive results with progression on of experimental AAA in a rat model. These data suggest that blockade of Ang II has an inhibitory effect on the development of AAA".

Are you differentiating BAV and Marfin Syndrome from the results you have experienced and posssible not applicable to those conditions?  Also, could the different measurements for your condition be within the margin of error?  There are theoretical reasons why ACE inhibitors might work better in Marfan's than ARBs alone.  The key defects in arterial structure are mediated through both angiotensin-2 type-1 (AT1) and angiotensin-2 type-2 receptor pathways, both of which are downregulated by ACE inhibition; ARBs directly inhibit only the AT1 receptor.

Marfan syndrome (MS) is a genetic disorder caused by a mutation in the fibrillin gene FBN1. Bicuspid aortic valve (BAV) is a congenital heart malformation of unknown cause. But statin and ARB might have inhibitory effects on the formation of aneurysms via hrough the suppression of NADH/NADPH oxidase.

Also, has size of AAA been considered...you have a measurement of AA that does not fit into the AA range (>4.0 cm).

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Avatar_m_tn
I went from a 4.3 cm CTA measurement of an aortic root and ascending aortic
aneurysm to a 4.1 cm measurement after a seven month time separation.
According to the radiologist it is not shrinkage, but rather natural differences like variation in aorta in systole and diastole phases. The radiology report stated there was no change, and this additional information resulted from my inquiry about the difference between the original 4.3 and the 2nd CTA result of 4.1cm. I have been on atenolol and recently switched, perhaps unwisely at my own request, to metoprolol. THe above information about valsartan and losartan seems contrary to the literature describing size as irreversible.
Daily variations in measurements may occur, but actual shrinkage seems
out of the question, according to what I have read. I am very curious if any further study on rats or otherwise has shown shrinkage. This is my first post here. I was diagnosed in November 2009 with ascending aortic aneurysm and at aortic root, with guess that valves are all right based on
normal echo. Echo of course showed root aneurysm, as did CTA, but echo was normal as to heart function and otherwise.
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Avatar_n_tn
"THe above information about valsartan and losartan seems contrary to the literature describing size as irreversible.
Daily variations in measurements may occur, but actual shrinkage seems
out of the question, according to what I have read. I am very curious if any further study on rats or otherwise has shown shrinkage. "

Your information is outdated.  ARB therapy results in ACTUAL shrinkage, not mere variation.  Not only have studies in rats shown dramatic shrinkage and total remodeling of the aortic root, but studies in humans have also been conducted and have demonstrated actual shrinkage (not measurement error) in humans.  Try googling "losartan and Marfan" as a starting point for your research.  Message me directly if you have questions.


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367994_tn?1304957193
Let's share the information with the forum if you please.
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Avatar_n_tn
Message me directly.  I don't check these forums frequently enough to know if you've posted and I'd hate for your questions to go unanswered.  If you want to copy and paste the exchange for everyone's benefit, please do so.
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Avatar_m_tn
HI PHALA
i have same problem.i am 42 yr old  male.  my arota size is 4.8cm.is realy help me this medicine(losartan).pls guide me.
thanks.
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