Medical management of coral reef aorta through optimised diuretic use and angiotensin receptor blockade

Coral reef aorta (CRA) is a rare condition with potentially devastating complications. It is characterised by atherosclerotic calcification and stenosis of the visceral part of the aorta, usually occurring at the juxtarenal or suprarenal locations, and causing refractory hypertension and renal dysfunction. Surgical intervention, which is the recommended definitive treatment, is associated with significant morbidity and mortality. Endovascular stenting has been reported to be an alternative management option. To the best of our knowledge, this is the first case report to describe medical management of a patient with CRA with diuretics and angiotensin receptor blockade without surgical treatment.

Angiotensin Receptor Blockade and Stereotactic Body Radiation Therapy for Early Stage Lung Cancer

BackgroundStereotactic body radiotherapy (SBRT) demonstrates excellent local control in early stage lung cancer, however a quarter of patients develop recurrence or distant metastasis. Transforming growth factor-beta (TGF-β) supports metastasis and treatment resistance, and angiotensin receptor blockade (ARB) indirectly suppresses TGF-β signaling. This study investigates whether patients taking ARBs while undergoing SBRT for early stage lung cancer exhibited improved overall survival (OS) or recurrence free survival (RFS) compared to patients not taking ARBs. MethodsThis was a single institution retrospective analysis of 272 patients treated with SBRT for early stage lung cancer between 2009-2018. Patient health data was abstracted from the electronic medical record. OS and RFS were assessed using Kaplan-Meier method. Log-rank test was used to compare unadjusted survival between groups. Univariable and multivariable Cox proportional hazard regression models were used to estimate hazard ratios (HRs). ResultsOf 247 patients analyzed, 24 (10%) patients took ARBs for the duration of radiotherapy. There was no difference in mean age, median tumor diameter, or median biologic effective dose between patients taking ARBs or not. Patients taking ARBs exhibited increased OS (ARB=96.7 mo.; no ARB= 43.3 mo.; HR=0.25 [95% CI: 0.10 to 0.62, P = .003]) and increased RFS (median RFS, ARB=64.3 mo.; No ARB=35.1 mo.; HR=0.26 [95% CI: 0.10 to 0.63, P = .003]). These effects were not seen in patients taking angiotensin converting enzyme inhibitors (ACEIs) or statins. ConclusionsARB use while undergoing SBRT for early stage lung cancer may increase OS and RFS, but ACEI use does not show the same effect.

Medical management of diabetic retinopathy

Medical management is focused on the proven benefit of tight glucose and blood pressure (BP) control. Standard management includes multiple cardiovascular risk factor management with angiotensin receptor blockade, statin, and fibrate treatment. Targets to achieve include HbA1c <7% (53 mmol/mol), BP <140/80, and serum cholesterol <4 mmol/L. A number of large recent trials have specifically demonstrated the beneficial effects on diabetic retinopathy (DR) of angiotensin receptor blockade (the DIRECT study) and fenofibrate (the fenofibrate intervention and event lowering in diabetes [FIELD] and action to control cardiovascular risk in diabetes [ACCORD] eye studies).