statins and endothelial function in patients with coarctation of the aorta

Conditions: Coarctation of the Aorta

Summary: coarctation of the aorta (coa) accounts for approximately 8% of all congenital heart problems. patients with coa are well known to have an increased rates of early heart disease, high blood pressure, heart failure and stroke. abnormal arterial function (dilation and constriction of the blood vessels) has been observed in these patients and likely contributes to the increased risk of cardiovascular problems. however, therapies targeted at improving arterial function have not been investigated in this population. statin therapy (cholesterol medicines like lipitor) have been studied in other subgroups of patients with abnormal arterial function and has shown benefit in improving arterial function and reducing risk of cardiovascular problems. the investigators hypothesize that patients with coa have abnormal arterial function leading to increased cardiovascular risk. we further hypothesize that statin therapy may improve this problem. we plan to compile a complete database of information regarding these patients cardiovascular health and propose to then examine the effect of atorvastatin (lipitor) on arterial function as measured by changes in arm arterial function tests.

the study design is a randomized double-blind cross over clinical trial. patients who meet inclusion criteria and no exclusion criteria will be enrolled. they will undergo a baseline cardiovascular assessment including echocardiography, magnetic resonance imaging or magnetic resonance angiography (mri/mra), serum blood samples, brachial artery reactivity testing, and carotid intimal media thickness testing. once they have completed their baseline testing, they will be randomized to either atorvastatin 80mg or placebo. they will complete 12 weeks of therapy and return at the end of 12 weeks to have a repeat brachial artery study and serum studies. there will then be a four week washout period where they take no medication. they will return for a follow up visit at the end of that four week period for repeat baseline brachial artery testing and serum studies. they then will be assigned to the opposite agent they were on previously (so if they originally were on placebo they switch to atorvastatin and vice versa). they will complete another 12 weeks of therapy and return at the end for a final brachial artery study and blood testing.

Eligibility criteria:
inclusion criteria: * patients over the age of 18 years with repaired coarctation of the aorta (coa) and willing to participate in all portions of the study including follow up, blood draws, urine sample, echocardiogram, mri, brachial artery flow-mediated dilatation (fmd) testing, carotid intima media thickness (cimt) testing and statin administration. exclusion criteria: * patients who are pregnant, nursing, or planning on becoming pregnant in the subsequent year * current smokers * patients with documented coronary artery disease (cad), other systemic inflammatory disorder such as systemic lupus erythematosis or rheumatoid arthritis * patients already on statin therapy or who have had previous adverse effects to statin therapy * patients with hepatic transaminases \>2x the upper limit of normal * patients with creatinine clearance \<60mg/dl * patients who have implanted devices such as pacemakers or defibrillators that preclude mri testing * patients with low blood pressure at baseline (\< 90/50) * patients who are unwilling or unable to comply with the aforementioned portions of the study

Keywords: coarctation of the aorta cross over design atorvastatin endothelial function