Abstract 3651: Ramipril Restores Impaired Endothelial Function And Decreases The Expression Of Proinflammatory Cytokines In Young Normotensive Subjects With Repaired Coarctation Of The Aorta
Background: Evidence suggests that coarctation of the aorta leads to impaired endothelial function in the pre-coarctation arterial tree and increased infammatory process, which persist many years after successful surgical repair. We examined the effect of ramipril on endothelial function and inflammatory process in young subjects with successfully repaired coarctation of the aorta.
Methods: Twenty normotensive subjects (27.3±2.4 years old) with successfully repaired coarctation of the aorta 11.4±1.3 years ago, were randomised to receive ramipril 5mg/d or no treatment for 4 weeks, in a single-blind, randomised cross-over prospective trial with a 4 weeks washout period between interventions. Endothelium-dependent dilation (EDD) was determined in the forearm by strain-gauge plethysmography. Serum CRP, interleukins 6 (IL-6) and 1b (IL-1b) were determined using by ELISA. Values expressed as means±SEM or median(25th–75th percentile).
Results: EDD was improved after ramipril (39.8±2.9% to 49.0±3.1% p<0.05) but not after control treatment (42.0±2.2% to 44.1±2.1% p=NS). Maximum hyperaemic flow was also increased after ramipril (7.21±1.1 ml/100ml tissue/min to 8.9±1.0 ml/100ml tissue/min p<0.05) but after control treatment (8.04±1.4 to 7.8±1.2ml/ 100ml tissue/min, p=NS). IL-6 was decreased after ramipril (2.33[1.35– 4.36] to 1.59[0.89–2.15] p<0.05) but not after control treatment (1.14[0.87– 4.19] to 1.45[0.92– 4.43] p=NS). IL-1b and CRP were slightly but not significantly decreased by ramipril.
Conclusions: Treatment with ramipril improved endothelium dependent dilation and decreases the expression of IL-6 in young normotensive subjects with successfully repaired coarctation of the aorta. These findings suggest that ramipril may have direct beneficial effects on vascular function and inflammatory process in patients with successfully repaired coarctation of the aorta.