Retardation of development and progression of coronary atherosclerosis: a new indication for calcium antagonists?
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 the Montreal 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. Native vessels without bypass grafts and segments distal to the peripheral graft anastomosis ("core region") 2. Segments bridged by bypass grafts and 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.(ABSTRACT TRUNCATED AT 250 WORDS)
Schneider
W
W
Division of Cardiology, University Hospital Frankfurt a.M.
Kober
G
G
Roebruck
P
P
Noack
H
H
Alle
M
M
Cieslinski
G
G
Reifart
N
N
Kaltenbach
M
M
D000818:Animals; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D004036:Diet, Atherogenic; D004110:Diltiazem / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D009529:Nicardipine / Q000627:therapeutic use; D011446:Prospective Studies; D011817:Rabbits; D012189:Retrospective Studies; D013997:Time Factors; D014700:Verapamil / Q000627:therapeutic use*
D014700:Verapamil; D009529:Nicardipine; D004110:Diltiazem