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[Modification of coronary arteriosclerosis in man by calcium antagonists?]
W Schneider1, P Roebruck, G Cieslinski
1Abteilung für Kardiologie, J. W. Goethe-Universität, Frankfurt a.M.
Insights
Calcium channel blockers may slow coronary arteriosclerosis by protecting blood vessels and improving cholesterol metabolism. Three trials using nifedipine, nicardipine, and verapamil showed promising results in retarding atherosclerosis progression.
Area of Science:
- Cardiovascular Pharmacology
- Atherosclerosis Research
- Clinical Trials
Context:
- Coronary arteriosclerosis is a significant health concern.
- Calcium channel blockers (CCBs) exhibit potential protective effects on vascular health.
- Previous animal and observational studies suggested CCBs could impede atherosclerosis.
Purpose:
- To evaluate the efficacy of CCBs in retarding the development and progression of coronary arteriosclerosis.
- To assess the impact of CCBs on lesion progression, new lesion formation, and vessel occlusion.
- To analyze results from prospective, placebo-controlled trials investigating CCBs in coronary artery disease.
Summary:
- Three prospective, placebo-controlled trials (INTACT, Montreal Heart Institute, FIPS) assessed CCBs (nifedipine, nicardipine, verapamil) over 2-3 years using serial angiograms.
- Studies evaluated CCB effects on lesion progression, new lesions, and occlusions in patients with early to advanced coronary artery disease, including post-bypass surgery.
- CCBs demonstrated potential in retarding atheroma development and progression in large arteries, as supported by animal models and clinical observations.
Impact:
- Findings suggest CCBs may play a role in managing coronary arteriosclerosis.
- Results contribute to understanding CCB mechanisms, including endothelial protection, vasodilation, and anti-proliferative effects.
- This research supports further investigation into CCBs for cardiovascular disease prevention and treatment.
Abstract:
Calcium channel blockers may retard development and progression of coronary arteriosclerosis in man because of protective effects on membranes, (especially the endothelium), relaxation of vessel walls, inhibition of various platelet functions, impairment of proliferation and migration of smooth muscle cells in the vessel wall, and an improvement of vascular cholesterol metabolism. In animal trials development of atheromas in large arteries induced by cholesterol-rich food and other stimuli of atherogenesis could be successfully retarded by a broad variety of calcium channel blockers. Some clinical observations in patients with coronary artery disease pointed at positive effects of calcium antagonists in coronary arteriosclerosis. To date, the results of three prospective placebo-controlled trials with calcium antagonists in coronary arteriosclerosis are available. In all trials progression of atherosclerosis was assessed by serial angiograms: 1) INTACT (nifedipine: 20 mg four times daily; observation period: 3 years, two coronary angiograms); 2) Study of the Montreal Heart Institute (nicardipine: 30 mg three times daily; observation period: 2 years, two coronary angiograms); 3) FIPS (Frankfurt Isoptin Progression Study) (verapamil: 120 mg three times daily; observation period: 3 years, three coronary angiograms). Target variables in these studies were progression or regression of preexisting lesions, development of new lesions and the incidence of vessel occlusions. The INTACT and the Nicardipine studies preferably included patients in early stages of coronary artery disease. The patients of FIPS who were entered into the study immediately after coronary bypass surgery suffered from severe, advanced coronary artery disease. In the latter study progression of coronary artery disease was assessed separately in different vascular regions (bypassed and non-bypassed segments) and in the bypass grafts.(ABSTRACT TRUNCATED AT 250 WORDS)