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Racial and ethnic differences in response to treatment for Marfan syndrome

Published online by Cambridge University Press:  13 April 2021

Rachel Ayers Open the ORCID record for Rachel Ayers [Opens in a new window] ,
Michael Kelleman ,
Glen Iannucci ,
Courtney McCracken  and
Matthew E. Oster
Rachel Ayers*
Affiliation:
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
Michael Kelleman
Affiliation:
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
Glen Iannucci
Affiliation:
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA Department of Pediatrics, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Courtney McCracken
Affiliation:
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
Matthew E. Oster
Affiliation:
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA Department of Pediatrics, Children’s Healthcare of Atlanta, Atlanta, GA, USA
*
Author for correspondence: Rachel Ayers, MD, Department of Pediatric Cardiology, Children’s Healthcare of Atlanta, Atlanta, GA 30341 USA. Tel: +1404-256-2593; Fax: 770- 488- 9477. E-mail: rachelayers02@gmail.com
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Abstract

Objective:

To determine whether racial/ethnic differences exist for the treatment of Marfan syndrome aortopathy. The 2014 Pediatric Heart Network randomised trial of losartan versus atenolol in Marfan syndrome paediatric and young adult patients showed no treatment differences in the rate of aortic root growth over 3 years; however, they did not examine racial/ethnic differences, and recent data suggest that angiotensin receptor blockers may have different pharmacologic effects in different racial/ethnic populations.

Methods:

We performed a secondary analysis of public-use data from the Pediatric Heart Network randomised trial comparing the differences by race/ethnicity (non-Hispanic White, non-Hispanic Black, and Hispanic patients) amongst the treatment groups for the primary outcome of rate of aortic root enlargement by z score and secondary outcome of rate of change of absolute diameter of aortic root, z score and absolute diameter of ascending aorta, and blood pressure changes.

Results:

For aortic root enlargement by z score amongst non-Hispanic White patients, patients on losartan exhibited an annual z score change of –0.090 ± 0.016, compared to –0.146 ± 0.015 for those on atenolol (p = 0.01), favouring atenolol. For Hispanic and non-Hispanic Black patients, there was no difference in primary or secondary outcomes between treatment groups.

Conclusion:

Non-Hispanic White patients had a small, but statistically significantly greater decrease in aortic root z score favouring atenolol over losartan. There were no significant differences amongst Hispanic or non-Hispanic Black patients, which may be due to relatively small size numbers. These findings may have important implications for medication selection by race/ethnicity in Marfan syndrome patients, which has not previously been evaluated in studies.

Keywords

Marfanaortopathytreatmentracial/ethnic differences
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 12 , December 2021 , pp. 1991 - 1998
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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Footnotes

The online version of this article has been updated since original publication. A notice detailing the changes has also been published.

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