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Retardation of development and progression of coronary atherosclerosis: a new indication for calcium antagonists?

Summary

Development of atherosclerotic lesions in animals, preferrably induced by a high-cholesterol diet, can be successfully suppressed by calcium channel blockers such as verapamil, nifedipine, nicardipine and diltiazem.

The issue of a beneficial effect of calcium channel blockers on human coronary atherosclerosis is however not yet settled. At present, three prospective randomized clinical trials with calcium channel blockers (Nifedipine, Verapamil, Nicardipine) are being conducted (INTACT, FIPS, Study of theMontreal Heart Institute). Target variable for assessment of progression in these studies is the severity of coronary atherosclerosis evaluated by angiography both at entry into the study and after 2–3 years of treatment.

A total of 445 patients after coronary bypass surgery (CABG) were entered in FIPS (Frankfurt Isoptin Progression Study) and randomly allocated to either verapamil 120 mg t. i. d. or placebo. The extent of coronary atherosclerosis is assessed by repeat angiography both 1 year and 3 years after randomization. Three vessel regions are evaluated separately:

  1. 1.

    Native vessels without bypass grafts and segments distal to the peripheral graft anastomosis (“core region”)

  2. 2.

    Segments bridged by bypass grafts and

  3. 3.

    Bypass grafts.

The 1-year follow-up was completed by 162 patients (Group A = 80 patients; Group B = 82 patients). There was a homogeneous distribution in the two groups for all clinical variables, graft patency rates, and the incidence of clinical events (myocardial infarction, need for cardiac surgery or PTCA, cardiac death).

The overall progression rate of atherosclerosis in the first year was expectedly low.

Thus, the question of whether calcium channel blockers can retard the progression of coronary atherosclerosis will be answered after completion of the prospective trials. The analysis of the data of these studies must take into account that the natural history of coronary atherosclerosis is characterized by slow progression over time.

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Schneider, W., Kober, G., Roebruck, P. et al. Retardation of development and progression of coronary atherosclerosis: a new indication for calcium antagonists?. Eur J Clin Pharmacol 39, S17–S23 (1990). https://doi.org/10.1007/BF03216270

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Key words

  • Calcium channel blockers
  • coronary atherosclerosis
  • verapamil
  • bypass surgery