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[Can the progression of coronary heart disease be modified by calcium antagonists?]
W Schneider1, P Roebruck, G Kober
1Abteilung für Kardiologie, Johann Wolfgang Goethe-Universität Frankfurt a. M.
Abstract:
Experimental atherosclerosis in animals preferentially induced by cholesterol-rich food can be successfully suppressed by calcium channel blocking agents such as verapamil, nifedipin, nicardipin, and diltiazem. The question whether calcium channel blockers can favorably influence atherosclerosis in humans remains a matter of debate. A few observational investigations in the past showed positive results of calcium channel blocker therapy in patients with angiographically proven coronary artery disease (CAD). At present three prospective randomized clinical trials are under way (INTACT-study, FIPS-study, study from the Montreal Heart Institute). Target variable is the severity of coronary atherosclerosis assessed by angiography both at entry into the study and after 2-3 years of treatment. 445 patients after coronary bypass surgery were included in the FIPS study (Frankfurt Isoptin Progression Study) and were randomly allocated to either verapamil 120 mg t.i.d. or placebo treatment. Extent of coronary atherosclerosis, assessed by repeat angiography 1 and 3 years after randomization, is expressed by scores with separate evaluation of non-bypassed vessels, segments distal to the peripheral bypass insertion, bypassed segments and grafts. The 1-year follow-up was completed for 162 patients (Group A = 80 patients; group B = 82 patients). There was a homogeneous distribution in both groups for all clinical variables, graft patency rates (76%/75%), and the incidence of clinical events (myocardial infarct, need for cardiac surgery or PTCA, cardiac death: 5%). The overall progression of atherosclerosis in the first year after bypass surgery was small. Thus, the question of whether calcium channel blockers can retard progression of coronary atherosclerosis cannot be answered before completion of the aforementioned trials.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Calcium channel blockers show promise in suppressing experimental atherosclerosis. However, their effect on human coronary artery disease progression requires further investigation through ongoing clinical trials.
Area of Science:
- Cardiovascular Research
- Pharmacology
Background:
- Experimental atherosclerosis in animals is suppressed by calcium channel blockers.
- Human studies on calcium channel blockers for coronary artery disease (CAD) show mixed results.
- Several prospective randomized clinical trials are underway to assess their efficacy.
Purpose of the Study:
- To evaluate the effect of calcium channel blockers on the progression of coronary atherosclerosis in humans.
- To assess if verapamil can favorably influence atherosclerosis in patients after coronary bypass surgery.
Main Methods:
- The Frankfurt Isoptin Progression Study (FIPS) enrolled 445 patients post-coronary bypass surgery.
- Patients were randomized to receive verapamil (120 mg t.i.d.) or placebo.
- Coronary atherosclerosis was assessed by angiography at baseline and 1, 3 years post-randomization.
Main Results:
- 162 patients completed the 1-year follow-up.
- Groups showed similar clinical variables, graft patency (76%/75%), and clinical events (5%).
- Overall atherosclerosis progression in the first year was minimal.
Conclusions:
- The 1-year follow-up of the FIPS study did not provide conclusive evidence on the efficacy of verapamil in retarding coronary atherosclerosis progression.
- Further results from ongoing trials are necessary to answer the question of whether calcium channel blockers can favorably influence human atherosclerosis.