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(Stroke. 2005;36:14.)
© 2005 American Heart Association, Inc.

Original Contributions

Concurrent Treatment With Renin-Angiotensin System Blockers and Acetylsalicylic Acid Reduces Nuclear Factor B Activation and C-Reactive Protein Expression in Human Carotid Artery Plaques

Katherine J.E. Sattler, MD; Julie E. Woodrum, MS; Offer Galili, MD; Monica Olson, BS; Saquib Samee, MD; Fredric B. Meyer, MD; Xiang-Yang Zhu, MD; Lilach O. Lerman, MD, PhD Amir Lerman, MD

From the Divisions of Cardiovascular Diseases, Nephrology, and Hypertension (K.J.E.S., J.E.W., O.G., M.O., S.S., A.L., X.-Y.Z., L.O.L.), Department of Internal Medicine; and the Department of Neurosurgery (F.B.M.), Mayo Clinic Rochester, Minn.

Correspondence to Amir Lerman, MD, Division of Cardiovascular Diseases Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905. E-mail lerman.amir{at}mayo.edu

Background and Purpose— The local renin-angiotensin system (RAS) and cyclooxygenase-2 contribute to the activation of nuclear factor B (NFB) and C-reactive protein (CRP). We hypothesized that the combination of RAS blockers (RASb) and ASA reduces NFB and CRP within atherosclerotic plaques.

Methods— Patients undergoing carotid endarterectomy were divided into groups according to treatment (RASb–acetylsalicylic acid [ASA], ASA, RASb, and control). The expression of NFB, CRP, and CD40L was analyzed through Western blots in the obtained plaques.

Results— Plaques from patients treated with the combination of RASb and ASA showed lower expression of NFB (25.4±9.8 densitometric units [DU]) than those of the control group (57.6±13.2 DU, P=0.03) as well as lower expression of CRP (20.9±9.6 DU) than those of the other treatment groups (ASA 86.1±13 DU, RASb 88.4±31 DU, controls 67.8±18.6, P=0.004). A negative expression of NFB was associated with a reduced incidence of symptoms compared with a positive expression (5/33 [15.1%] versus 14/35 [40%], P=0.031).

Conclusions— The combined treatment with RASb and ASA decreases the expression of inflammatory markers in atherosclerosis in humans. This study supports the role of the local RAS and cyclooxygenase-2 in the progression of atherosclerosis.

Key Words: aspirin • atherosclerosis • carotid endarterectomy • growth factors • inflammation

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