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Objectives The purpose of this study was to evaluate whether an angiotensin II receptor blocker, candesartan cilexetil, reduced neointima formation after coronary stent implantation by way of serial intravascular ultrasound analysis. Background Previous experimental studies have suggested that angiotensin II receptor blocker reduced neointima formation after vascular injury. However, it is unclear whether candesartan cilexetil has a similar effect on human coronary artery. Methods We recruited 50 consecutive patients with stable angina pectoris and 60 stenotic lesions. Patients were prospectively randomized into 2 groups: (1) 25 patients with 31 lesions received candesartan cilexetil (4-12 mg/d), and (2) 25 patients with 29 lesions did not receive the drug. Follow-up intravascular ultrasound was performed 6 m after the stent implantation. Cross-sectional images were obtained at 1-mm intervals within the stent, and the stent volume (SV), lumen volume (LV), and neointima volume (NV = SV − LV) were calculated using Simpson's rule. The percentage neointima volume obstruction (%NV) was calculated as NV/SV × 100. Results Clinical and angiographic backgrounds were comparable between the 2 groups. At follow-up, the candesartan group had smaller SV and larger LV (SV, 156.3 ± 53.7 vs 165.4 ± 61.8 mm 3 , ns; LV, 122.2 ± 49.0 vs 113.1 ± 45.5 mm 3 , ns), and significantly smaller NV and significantly smaller %NV than the control group (NV, 34.2 ± 16.6 vs 52.3 ± 32.6 mm 3 , P P Conclusions Candesartan treatment decreases neointima formation and hence may reduce in-stent restenosis.

In Japan the majority of sarcoidosis-related deaths are due to cardiac sarcoidosis. One of the most common electrocardiographic abnormalities in patients with this disease is atrioventricular block. This study surveyed the incidence of cardiac sarcoidosis in Japanese patients (40 men and 49 women; mean age, 69.1 years) with high-degree atrioventricular block who were admitted to the hospital to receive a permanent pacemaker. We excluded cases in which sarcoidosis had been diagnosed from the involvement of other organs. Patients with the characteristic signs of sarcoidosis underwent echocardiography, radionuclide imaging, and biopsy. Ten cases (11.2%) of cardiac sarcoidosis were diagnosed, most frequently in women aged 40 to 69 years (8 of 25, 32%). Thus the possibility of cardiac sarcoidosis should be carefully considered in middle-aged or elderly Japanese women who show high-degree atrioventricular block.

The purpose of this study was to evaluate whether an angiotensin II receptor blocker, candesartan cilexetil, reduced neointima formation after coronary stent implantation by way of serial intravascular ultrasound analysis.Previous experimental studies have suggested that angiotensin II receptor blocker reduced neointima formation after vascular injury. However, it is unclear whether candesartan cilexetil has a similar effect on human coronary artery.We recruited 50 consecutive patients with stable angina pectoris and 60 stenotic lesions. Patients were prospectively randomized into 2 groups: (1) 25 patients with 31 lesions received candesartan cilexetil (4-12 mg/d), and (2) 25 patients with 29 lesions did not receive the drug. Follow-up intravascular ultrasound was performed 6 m after the stent implantation. Cross-sectional images were obtained at 1-mm intervals within the stent, and the stent volume (SV), lumen volume (LV), and neointima volume (NV = SV - LV) were calculated using Simpson's rule. The percentage neointima volume obstruction (%NV) was calculated as NV/SV x 100.Clinical and angiographic backgrounds were comparable between the 2 groups. At follow-up, the candesartan group had smaller SV and larger LV (SV, 156.3 +/- 53.7 vs 165.4 +/- 61.8 mm3 , ns; LV, 122.2 +/- 49.0 vs 113.1 +/- 45.5 mm3 , ns), and significantly smaller NV and significantly smaller %NV than the control group (NV, 34.2 +/- 16.6 vs 52.3 +/- 32.6 mm3 , P.01; %NV, 22.7 +/- 10.9% vs 31.3 +/- 13.4%, P.01).Candesartan treatment decreases neointima formation and hence may reduce in-stent restenosis.

The renin-angiotensin system is important in cardiovascular remodeling. Although a variant of the angiotensinogen gene is associated with an increased generation of angiotensinogen, it is unclear how this genetic variant might influence the activity of the renin-angiotensin system and thereby contribute to the predisposition to coronary artery disease (CAD). The relation between genetic polymorphisms in the gene-encoding angiotensinogen and the risk of CAD in middle-aged Japanese men was investigated. Two polymorphisms in exon 2 of the angiotensinogen gene, M235T and T174M, were analyzed in 327 patients with CAD and 352 matched control subjects. The genotype distribution of both polymorphisms did not differ between patients with CAD and control subjects. No combination of genotypes of the two polymorphisms was associated with CAD. Results indicate that the M235T and T174M variants of the angiotensinogen gene are not associated with CAD in Japanese men.