Related Experiment Videos
Progress in cardioprotection: the role of calcium antagonists
1Heart Institute, Hospital of the Good Samaritan, Los Angeles, California 90017.
Insights
Calcium antagonists effectively treat hypertension and angina. Emerging research suggests potential cardioprotective roles, including slowing atherosclerotic progression, expanding their therapeutic applications.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Calcium antagonists are established treatments for hypertension and angina pectoris.
- They demonstrate efficacy in various angina types and reduce silent ischemia incidence.
Purpose of the Study:
- To explore the broader therapeutic potential of calcium antagonists beyond hypertension and angina.
- To investigate their cardioprotective properties and effects on atherosclerosis.
Main Methods:
- Review of clinical and experimental data on calcium antagonist usage.
- Analysis of studies examining effects on myocardial ischemia, infarction, and ventricular function.
- Evaluation of impact on atherosclerotic progression and hypertrophic cardiomyopathy.
Main Results:
- Calcium antagonists show promise in managing myocardial ischemia, stunned myocardium, and diastolic dysfunction.
- Experimental data suggest cardioprotective effects, including reduced necrosis and enhanced ventricular function recovery.
- Nifedipine demonstrated potential in slowing atherosclerotic progression in human studies.
Conclusions:
- Calcium antagonists offer benefits beyond primary indications, including potential cardioprotection.
- Further research supports expanding their use for cardiovascular conditions and atherosclerosis management.
- The possibility of delaying or regressing atherosclerotic lesions is a significant finding.
Abstract:
Calcium antagonists are now widely used for the treatment of clinical hypertension and angina pectoris. They are efficacious for the treatment of vasospastic, fixed atherosclerotic and mixed angina; they reduce the incidence of silent ischemia; and they have been shown to reduce postmyocardial infarct angina. Experimental data suggest that they may have certain cardioprotective properties in cases of acute myocardial ischemia and infarction, stunned myocardium, diastolic dysfunction, left ventricular hypertrophy and atherosclerosis. Moreover, they have been shown to improve exercise performance, as well as the diastolic abnormalities in patients with hypertrophic cardiomyopathy. In animals, they may delay or reduce the extent of myocardial necrosis after coronary occlusion or coronary occlusion followed by reperfusion, and in low doses that do not alter the hemodynamic profile, they have been shown to enhance the return of ventricular function in animals with stunned myocardium. However, the early first-generation calcium antagonists (nifedipine, verapamil, diltiazem) have not been shown to reduce myocardial infarct size or to enhance survival in patients with acute myocardial infarction. There now are clinical studies that suggest that, unlike beta blockers or nitrates, nifedipine may slow the development of atherosclerotic progression in humans over a 2-year period, and it seems likely that in the 1990s there will be further expansion of the use of calcium antagonists for not only angina and hypertension but also for aspects of cardioprotection. That calcium antagonists may delay, prevent or possibly regress atherosclerotic lesions is an exciting possibility.