Can rimonabant slow atherosclerosis?

Researchers at the University of Rochester Medical Center has announced that they have launched a study to determine whether an experimental drug, rimonabant, can slow atherosclerosis, the fatty build-up in arteries that creates heart attack risk.

In recent studies, rimonabant has been shown to decrease body weight, improve abnormal levels of blood sugars and fats (cholesterol) and to help willing patients quit smoking. Now researchers hope to add coronary artery disease (CAD), atherosclerosis within the arteries of the heart, to the list of maladies addressed. A decision on whether rimonabant is safe and effective and if so, for which uses, is expected from the U.S. Food and Drug Administration in 2006.

Unlike previous cholesterol drugs that treat some aspect of blood or blood vessel walls, rimonabant is a cannabinoid receptor antagonist, which exerts its effect in parts of the brain that control appetite and addictive behaviors.

Results of previous studies show that rimonabant reduces triglycerides and increases HDL-C, or "good" cholesterol, independent of weight loss. The new study, titled STADIVARIUS (Strategy to Reduce Atherosclerosis Development Involving Administration of Rimonabant- The Intravascular Ultrasound Study), will explore whether these effects will impact the progression of atherosclerosis.

"Obesity, diabetes, high cholesterol and coronary artery disease have all reached epidemic proportions to become leading causes of death despite being largely preventable," said Frederick S. Ling, M.D., director of the Cardiac Catheterization Laboratory, associate professor of Medicine at the medical center and principal investigator for STRADIVARIUS. "These risk factors, called metabolic syndrome when combined in one person, feed off each other and are made much worse by smoking. New approaches are urgently needed, and our lab has the tools to measure accurately whether new treatments actually slow the progression of coronary artery disease."

Specifically, people with metabolic syndrome have at least three of the following risk factors: abdominal obesity, high blood pressure, insulin resistance/high blood sugar (precursor to diabetes), and blood lipid disorders (high triglycerides or low good cholesterol (HDL-C)). The 50 million Americans with the syndrome are at increased risk for CAD, which takes 500,000 lives per year, according to the American Heart Association. By further worsening disease in coronary arteries, smoking puts 47 million Americans at even greater risk.

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