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Can the coronary atherosclerotic process be influenced by calcium antagonists?
G Kober1, W Schneider, G Cieslinski
1Clinic Nordrhein, Bad Nauheim, Federal Republic of Germany.
Abstract:
Cell culture experiments and various animal models have shown that calcium antagonists can inhibit atheroma development. A number of antiatherosclerotic mechanisms have been proposed and the promising results of these in vitro and animal experiments prompted clinical trials. Retrospective analyses indicated that verapamil might retard disease progression and the development of new stenoses. Prospective clinical studies, however, have revealed no effect by calcium antagonists on pre-existing coronary stenoses (> or = 20%) and it is suggested that the study duration (2 to 3 years) may have been too short and that advanced stages of atheromatous disease are not influenced by calcium antagonists. Current data suggest that only early stages of coronary atheromatosis may be affected by treatment with calcium antagonists; however, optimum drug, dosage and suitable patients are yet to be defined.
Insights
Calcium antagonists may inhibit early atheroma development, but clinical trials show no effect on existing coronary stenoses. Further research is needed to define optimal use for early-stage coronary atheromatosis.
Area of Science:
- Cardiovascular research
- Pharmacology
- Atherosclerosis studies
Background:
- Calcium antagonists have demonstrated potential in inhibiting atheroma development in cell cultures and animal models.
- Proposed antiatherosclerotic mechanisms and promising preclinical results led to clinical investigations.
Purpose of the Study:
- To evaluate the efficacy of calcium antagonists in preventing atheroma development and disease progression.
- To assess the impact of calcium antagonists on pre-existing coronary stenoses.
Main Methods:
- In vitro cell culture experiments.
- Animal models of atheroma development.
- Retrospective and prospective clinical trials evaluating coronary stenoses.
Main Results:
- Calcium antagonists showed promise in inhibiting atheroma in preclinical studies.
- Retrospective analyses suggested verapamil might slow disease progression.
- Prospective studies found no effect on established coronary stenoses (> or = 20%).
Conclusions:
- Calcium antagonists may only influence early stages of coronary atheromatosis.
- Current clinical data do not support their use for pre-existing stenoses.
- Optimal drug, dosage, and patient selection for early-stage treatment remain undefined.