Calcium channel blockers and coronary heart disease

Calcium channel blockers (CCBs) are drugs with several pharmacological properties, widely used in cardiovascular medicine for a variety of indications, including treatment of hypertension and angina pectoris. This review summarizes the most recent evidence on coronary outcomes of CCBs, used either to treat hypertension or in secondary prevention of overt coronary heart disease (CHD). The anti-atherosclerotic properties of these drugs will also be reviewed. Several randomized trials and meta-analyses published from the mid-1990s indicate that, as a class, CCBs are superior to placebos in preventing CHD events in patients with hypertension, although in head-to-head comparisons with other antihypertensive agents their effects are more controversial and largely dependent on the specific CCB considered. Conversely, older studies report that short-acting CCBs may increase the risk of CHD outcomes, a finding contradicted by recent trials on long-acting, lipophilic agents. In patients with prevalent CHD, CCBs do not improve survival and most major CHD outcomes, although they reduce symptoms of angina and the need for revascularization procedures also in active treatment comparisons. Besides their action on blood pressure and on coronary vessel smooth muscle, this protective effect is probably mediated by their plaque stabilization properties.