Effect of Ticagrelor Versus Clopidogrel on Aortic Stiffness in Patients With Coronary Artery Disease

BACKGROUND: We compared the acute and midterm effect of ticagrelor versus clopidogrel on aortic stiffness. METHODS AND RESULTS: We studied 117 patients in a randomized, assessor‐blinded, parallel‐group trial. The acute effect of ticagrelor was studied in 58 patients randomized (1:1) to receive a loading dose of clopidogrel (600 mg) or ticagrelor (180 mg). Carotid‐femoral pulse wave velocity (cfPWV) was measured before, 3, and 24 hours after the loading dose. The midterm effect (30‐day treatment period) was studied in 59 subjects who underwent percutaneous coronary intervention and were randomized to either clopidogrel (75 mg, OD) or ticagrelor (90 mg BID). cfPWV was measured before and at 30 days of treatment. Circulating markers of inflammation and endothelial function were measured at all study points. Repeated‐measures analysis showed a significant main effect for treatment (P=0.03), with the ticagrelor showing a reduction in cfPWV after treatment. cfPWV at 24 hours was significantly lower in the ticagrelor group compared with the clopidogrel group (P=0.017) (maximal response reduction by 0.42±0.26 m/s). At 30 days, cfPWV decreased in the ticagrelor group, whereas there was no change with clopidogrel (−0.43±0.57 versus 0.12±0.14 m/s, P=0.004). There were no significant changes in both the acute and midterm study period in the pro‐inflammatory and endothelial function parameters. CONCLUSIONS: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02071212. Ticagrelor decreases cfPWV for 24 hours after the loading dose and at 1 month post–percutaneous coronary intervention compared with clopidogrel. Considering that aortic stiffness is an independent predictor of cardiovascular events, this finding may have clinical implications regarding the beneficial effect of ticagrelor. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02071212.