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Retardation of development and progression of coronary atherosclerosis: a new indication for calcium antagonists?
W Schneider1, G Kober, P Roebruck
1Division of Cardiology, University Hospital Frankfurt a.M.
Abstract:
Development of atherosclerotic lesions in animals, preferrably induced by a high-cholesterol diet, can be successfully suppressed by calcium channel blockers such as verapamil, nifedipine, nicardipine and diltiazem. The issue of a beneficial effect of calcium channel blockers on human coronary atherosclerosis is however not yet settled. At present, three prospective randomized clinical trials with calcium channel blockers (Nifedipine, Verapamil, Nicardipine) are being conducted (INTACT, FIPS, Study of the Montreal Heart Institute). Target variable for assessment of progression in these studies is the severity of coronary atherosclerosis evaluated by angiography both at entry into the study and after 2-3 years of treatment. A total of 445 patients after coronary bypass surgery (CABG) were entered in FIPS (Frankfurt Isoptin Progression Study) and randomly allocated to either verapamil 120 mg t.i.d. or placebo. The extent of coronary atherosclerosis is assessed by repeat angiography both 1 year and 3 years after randomization. Three vessel regions are evaluated separately. 1. Native vessels without bypass grafts and segments distal to the peripheral graft anastomosis ("core region") 2. Segments bridged by bypass grafts and 3. Bypass grafts. The 1-year follow-up was completed by 162 patients (Group A = 80 patients; Group B = 82 patients). There was a homogeneous distribution in the two groups for all clinical variables, graft patency rates, and the incidence of clinical events (myocardial infarction, need for cardiac surgery or PTCA, cardiac death). The overall progression rate of atherosclerosis in the first year was expectedly low.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Calcium channel blockers show promise in animal models for suppressing atherosclerosis. Human trials are ongoing to determine their effect on coronary atherosclerosis progression after bypass surgery.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
Background:
- Calcium channel blockers (CCBs) effectively suppress atherosclerosis in animal models.
- The impact of CCBs on human coronary atherosclerosis remains under investigation.
- Several prospective randomized clinical trials are evaluating CCBs for coronary atherosclerosis.
Purpose of the Study:
- To assess the effect of verapamil on the progression of coronary atherosclerosis in patients post-coronary artery bypass grafting (CABG).
- To evaluate atherosclerosis progression in native vessels, bypass graft segments, and bypass grafts over three years.
Main Methods:
- The Frankfurt Isoptin Progression Study (FIPS) enrolled 445 patients post-CABG, randomized to verapamil or placebo.
- Coronary atherosclerosis severity was assessed by angiography at baseline, 1 year, and 3 years.
- Atherosclerosis progression was evaluated separately in native vessels, graft-bridged segments, and bypass grafts.
Main Results:
- 162 patients completed the 1-year follow-up, with homogeneous distribution of clinical variables and graft patency between verapamil and placebo groups.
- The overall rate of atherosclerosis progression in the first year was low.
- No significant differences in clinical events (myocardial infarction, need for re-intervention, cardiac death) were reported at 1 year.
Conclusions:
- The 1-year data from the FIPS trial suggest a low rate of atherosclerosis progression in patients treated with verapamil post-CABG.
- Further analysis of the 3-year follow-up data is required to fully ascertain the efficacy of verapamil in preventing coronary atherosclerosis progression.