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Published on: October 18, 2018
Calcium channel blockers and cardiovascular outcomes: a meta-analysis of 175,634 patients
Pierluigi Costanzo1, Pasquale Perrone-Filardi, Mario Petretta
1Department of Internal Medicine, Cardiovascular Sciences and Immunology, Federico II University, Via S. Pansini, Naples, Italy. pcostanz@alice.it
Insights
Calcium channel blockers (CCBs) reduce all-cause mortality risk compared to active therapy and prevent heart failure when compared to placebo. CCBs also decrease stroke risk and do not increase risks of cardiovascular death, myocardial infarction, or major cardiovascular events.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Calcium channel blockers (CCBs) are widely used antihypertensive agents.
- Their comparative safety and efficacy regarding mortality and major cardiovascular events require ongoing assessment.
Purpose of the Study:
- To evaluate the impact of CCB treatment versus other drugs or placebo on all-cause mortality, cardiovascular death, major cardiovascular events, heart failure, myocardial infarction, and stroke.
- To synthesize evidence from randomized controlled trials (RCTs) to provide a comprehensive safety and efficacy profile of CCBs.
Main Methods:
- A meta-analysis of 27 RCTs involving 175,634 patients was conducted.
- Studies compared long-acting CCBs with alternative drug therapies or placebo, assessing predefined cardiovascular outcomes and mortality.
Main Results:
- Dihydropyridine CCBs were associated with a reduced risk of all-cause death (OR 0.96).
- CCBs increased heart failure risk versus active treatment but decreased it versus placebo.
- No increased risk of myocardial infarction, cardiovascular death, or major cardiovascular events was observed.
- CCBs significantly reduced the risk of fatal or nonfatal stroke (OR 0.86), including when compared to ACE inhibitors.
Conclusions:
- CCBs demonstrate a benefit in reducing all-cause mortality when compared to active therapies.
- CCBs are effective in preventing heart failure, particularly when contrasted with placebo.
- The findings confirm CCBs' efficacy in stroke prevention and their neutral effect on cardiovascular death, myocardial infarction, and major adverse cardiovascular events.
Objective:
The aim of this study was to assess the effect of calcium channel blocker (CCB) treatment, compared with other drugs or placebo/top of therapy, on all-cause mortality, cardiovascular death, major cardiovascular events, heart failure, myocardial infarction and stroke.
Methods:
We performed a meta-analysis of randomized controlled trials that compared a long-acting calcium channel blocker with another drug or placebo/top of therapy and that assessed all-cause mortality and cardiovascular events.
Results:
We included 27 trials (175,634 patients). The risk of all-cause death was reduced by dihydropyridine CCBs [odds ratio (OR) 0.96; 95% confidence interval (CI) 0.93-0.99; comparison P = 0.026; heterogeneity P = 0.87)] without influence of placebo trials. The risk of heart failure was increased by CCBs compared with active treatment (OR 1.17; 95% CI 1.11-1.24; comparison P = 0.0001; heterogeneity P = 0.0001), and it was decreased when compared with placebo (OR 0.72; 95% CI 0.59-0.87; comparison P = 0.001; heterogeneity P = 0.77), also in the subgroup of coronary artery disease patients (OR 0.76; 95% CI 0.61-0.95; comparison P = 0.01; heterogeneity P = 0.29). CCBs did not increase the risk of myocardial infarction (OR 1; 95% CI 0.95-1.04; comparison P = 0.83, heterogeneity P = 0.004), cardiovascular death (OR 0.97; 95% CI 0.93-1.02; comparison P = 0.24; heterogeneity P = 0.16), major cardiovascular events (OR 0.97; 95% CI 0.90-1.06; comparison P = 0.53; heterogeneity P = 0.0001). CCBs decreased the risk of fatal or nonfatal stroke (OR 0.86; 95% CI 0.82-0.90; comparison P = 0.0001, heterogeneity P = 0.12), also, when compared with angiotensin-converting enzyme inhibitors (OR 0.87; 95% CI 0.78-0.97; comparison P = 0.016; heterogeneity P = 0.48).
Conclusion:
Our study demonstrates that CCBs reduce the risk of all-cause mortality compared with active therapy and prevent heart failure compared with placebo. Furthermore, with the inclusion of recent trials, we confirm that they reduce the risk of stroke, also in comparison to angiotensin-converting enzyme inhibitors and do not increase the risk of cardiovascular death, myocardial infarction and major cardiovascular events.
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