{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T13:30:34Z","timestamp":1790256634600,"version":"4.1.0"},"reference-count":31,"publisher":"American Medical Association (AMA)","issue":"13","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2007,10,3]]},"abstract":"\n Context<\/jats:title>\n Aortic stiffness is increased in Marfan syndrome contributing to aortic dilatation and rupture, the major cause of premature death in this population. Angiotensin-converting enzyme inhibitors have been shown to reduce arterial stiffness.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine whether perindopril therapy reduces aortic stiffness and attenuates aortic dilatation in patients with Marfan syndrome.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n A randomized, double-blind, placebo-controlled trial of 17 patients with Marfan syndrome (mean [SD], 33 [6] years) taking standard \u03b2-blocker therapy, initiated in January 2004 and completed in September 2006, at Alfred Hospital Marfan Syndrome Clinic, Melbourne, Australia.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Patients were administered 8 mg\/d of perindopril (n\u00a0=\u00a010) or placebo (n\u00a0=\u00a07) for 24 weeks.<\/jats:p>\n <\/jats:sec>\n \n Main Outcome Measures<\/jats:title>\n Indices of arterial stiffness were assessed via systemic arterial compliance, and central and peripheral pulse wave velocities. Aortic root diameters were assessed at 4 sites via transthoracic echocardiography.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Perindopril reduced arterial stiffness as indicated by increased systemic arterial compliance (mean [SEM], 0.33 [0.01] mL\/mm Hg at baseline to 0.54 [0.04] mL\/mm Hg at 24 weeks in perindopril group vs 0.30 [0.01] mL\/mm Hg to 0.29 [0.01] mL\/mm Hg in placebo group,\n P<\/jats:italic>\n \u00a0=\u00a0.004), and reduced central (7.6 [0.4] m\/s to 5.9 [0.3] m\/s in perindopril group,\n P<\/jats:italic>\n \u00a0&amp;lt;\u00a0.001 vs placebo) and peripheral (10.9 [0.4] m\/s to 8.7 [0.4] m\/s in perindopril group,\n P<\/jats:italic>\n \u00a0&amp;lt;\u00a0.001 vs placebo) pulse wave velocities. In addition, perindopril significantly reduced aortic root diameters relative to placebo in both end-systole and end-diastole (\n P<\/jats:italic>\n &amp;lt;.01 to\n P<\/jats:italic>\n \u00a0&amp;lt;\u00a0.001 for all comparisons between groups). Although perindopril marginally reduced mean arterial pressure (from 81 [2] mm Hg to 80 [1] mm Hg in perindopril group vs 83 [2] mm Hg to 84 [3] mm Hg in placebo group,\n P<\/jats:italic>\n \u00a0=\u00a0.004), the observed changes in both stiffness and left ventricular outflow tract diameter remained significant when mean arterial pressure was included as a covariate. Transforming growth factor \u03b2 (TGF-\u03b2), which contributes to aortic degeneration in Marfan syndrome, was reduced by perindopril compared with placebo in both latent (59 [6] ng\/mL to 45 [3] ng\/mL in perindopril group,\n P<\/jats:italic>\n \u00a0=\u00a0.01 vs placebo) and active (46 [2] ng\/mL to 42 [1] ng\/mL in perindopril group,\n P<\/jats:italic>\n \u00a0=\u00a0.02 vs placebo) forms.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Perindopril reduced both aortic stiffness and aortic root diameter in patients with Marfan syndrome taking standard \u03b2-blocker therapy, possibly through attenuation of TGF-\u03b2 signaling. Large clinical trials are needed to assess the clinical benefit of angiotensin II blockade in Marfan syndrome.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n clinicaltrials.gov Identifier:\n NCT00485368<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.298.13.1539","type":"journal-article","created":{"date-parts":[[2007,10,2]],"date-time":"2007-10-02T16:18:23Z","timestamp":1191341903000},"page":"1539","source":"Crossref","is-referenced-by-count":147,"title":["RETRACTED: Effect of Perindopril on Large Artery Stiffness and Aortic Root Diameter in Patients With Marfan Syndrome"],"prefix":"10.1001","volume":"298","author":[{"given":"Anna A.","family":"Ahimastos","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anuradha","family":"Aggarwal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kellie 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