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Pharmacologic effects of calcium channel blockers on restenosis
1Medical Department B, University Hospital Oslo, Norway.
Insights
Calcium channel blockers, like amlodipine, may reduce restenosis after coronary angioplasty. The CAPARES study investigates amlodipine
Area of Science:
- Cardiology
- Pharmacology
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) healing and restenosis pathogenesis are not fully understood.
- Stent implantation is the only proven method to reduce restenosis rates.
- Calcium channel blockers may mitigate restenosis by reducing platelet aggregation, vasospasm, and mitogen activity.
Purpose of the Study:
- To assess the effect of amlodipine, a third-generation calcium channel blocker, on restenosis and ischemia in patients undergoing angioplasty.
- To evaluate amlodipine's potential anti-ischemic and anti-restenotic effects.
- To determine if amlodipine improves long-term outcomes of PTCA therapy.
Main Methods:
- A meta-analysis of five trials showed a 30% reduction in restenosis risk with calcium channel blockers.
- The Coronary Angioplasty Amlodipine Restenosis Study (CAPARES) is evaluating amlodipine.
- Patients receive amlodipine (5-10 mg daily) or placebo, starting two weeks before and continuing four months after angioplasty.
Main Results:
- A meta-analysis of five trials demonstrated a 30% reduction in the risk for restenosis with calcium channel blockers.
- The CAPARES study is designed to assess amlodipine's efficacy.
- Amlodipine may offer superior benefits compared to previously studied calcium channel blockers.
Conclusions:
- Amlodipine may provide anti-ischemic protection peri-procedurally and post-angioplasty.
- The study hypothesizes amlodipine will have beneficial effects on restenosis and clinical endpoints.
- Improved long-term outcomes following PTCA are anticipated with amlodipine therapy.
Abstract:
The understanding and control of the healing process after percutaneous transluminal coronary angioplasty (PTCA) and of the pathogenesis of restenosis are incomplete. To date, only stent implantation has been shown to successfully reduce the rate of restenosis. Calcium channel blockers have positive effects on a number of processes that may be associated with restenosis, including reduction of platelet aggregation, minimization of vasospasm, and inhibition of mitogens. Clinical trials have therefore been performed to assess the effect of calcium channel blockers on restenosis and ischemia. A meta-analysis of five restenosis trials investigating calcium channel blockers demonstrated a 30% reduction in the risk for restenosis. The Coronary Angioplasty Amlodipine Restenosis Study (CAPARES) is therefore assessing the effect of amlodipine, a long-acting, third-generation calcium channel blocker in angioplasty patients. Therapy (amlodipine 5 mg with a forced titration to 10 mg once daily, or placebo), is begun 2 weeks before angioplasty and is continued for 4 months after the procedure. The rationale of CAPARES is that amlodipine may offer anti-ischemic protection before, during, and after angioplasty, may have more beneficial effects on restenosis and various clinical end points than calcium channel blockers used in previous trials, and may improve the long-term outcome of PTCA therapy.