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Impact of Calcium Channel Blockers on Aspirin Reactivity in Patients with Coronary Artery Disease
Afek Kodesh1,2, Eli Lev3, Dorit Leshem-Lev1,2,4
1Cardiovascular Division, Rabin Medical Center, Beilinson Hospital, 39 Jabotinsky St, 4941492, Petah-Tikva, Israel.
Insights
Calcium channel blockers (CCBs) are linked to increased aspirin resistance in patients with stable coronary artery disease (CAD). This suggests CCBs may have an adverse pharmacologic effect when used with aspirin.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Calcium channel blockers (CCBs) are commonly prescribed for hypertension and angina.
- CCBs have not demonstrated a reduction in myocardial infarction (MI) risk in stable coronary artery disease (CAD).
- Aspirin resistance is a concern in patients with CAD, potentially leading to adverse cardiovascular events.
Purpose of the Study:
- To investigate the association between CCB use and aspirin resistance in patients with stable CAD.
- To determine if CCBs influence platelet reactivity in patients taking aspirin.
Main Methods:
- A study included 503 patients with stable CAD on aspirin therapy.
- Platelet function was assessed using the VerifyNow system, defining high on-aspirin platelet reactivity (HAPR) as ARU >550.
- Patients were categorized into CCB and control groups for comparison.
Main Results:
- Patients treated with CCBs showed significantly higher mean aspirin reaction units (ARU) (465.4±70.0 vs. 445.2±60.0, p=0.006).
- HAPR was observed in 15.9% of CCB users versus 7.0% of controls (p=0.006).
- CCB administration was independently associated with HAPR in multivariate and propensity score matched analyses (OR 1.72 and 1.56, respectively).
Conclusions:
- CCB usage is positively correlated with aspirin resistance in patients with stable CAD.
- These findings suggest a potential adverse pharmacologic interaction between CCBs and aspirin.
- Further research is warranted to explore the clinical implications of this association.
Purpose:
Calcium channel blockers (CCBs) do not reduce the risk of initial or recurrent myocardial infarction (MI) in patients diagnosed with stable coronary artery disease (CAD). The aim of this current study was to evaluate the association between CCBs and aspirin resistance in patients with CAD.
Methods:
Patients with stable CAD who were regularly taking aspirin (75-100 mg qd) for at least 1 month prior to enrollment in the study were included. The VerifyNow system was used for platelet function testing with high on-aspirin platelet reactivity (HAPR) defined as aspirin reaction units (ARU) >550. We compared patients treated with CCBs versus control group.
Results:
Five hundred three patients with CAD were included in this study, and 88 were treated with CCBs. Mean age (67.9±9.7 in the CCB group vs. 66.5±11.4 in the control group), gender (77.3 male vs. 82.9%), rates of diabetes mellitus (34.7 vs. 36.9%), rates of CKD (23.5 vs. 23.5%), dyslipidemia (85.1 vs. 85.3%), and statin therapy (89.5 vs. 90.7%) were similar. The mean ARU was 465.4±70.0 for patients treated with CCBs versus 445.2±60.0 in controls (p=0.006). Similarly, 15.9% of CCB patients demonstrated HAPR compared to 7.0% (p=0.006). The administration of CCBs was independently associated with HAPR in a multivariate analysis (OR 1.72, 95% CI: 1.04-8.91, p=0.047) as well as in propensity score matched analysis (OR 1.56; CI: 1.22-1.93; p<0.001).
Conclusions:
Usage of CCBs is positively correlated with aspirin resistance. These findings may suggest an adverse pharmacologic effect of CCBs among patients with stable CAD treated with aspirin.
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