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Diltiazem for long-term therapy of coronary arterial spasm
Insights
Diltiazem significantly reduces angina attacks in patients with coronary arterial spasm. This calcium channel blocker is well-tolerated for long-term treatment, offering substantial relief from chest pain.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Coronary arterial spasm is a condition causing chest pain.
- Effective long-term treatment options for this condition are crucial.
Purpose of the Study:
- To evaluate the efficacy and tolerability of diltiazem for treating coronary arterial spasm.
- To assess the long-term outcomes of diltiazem therapy in patients with angina at rest.
Main Methods:
- A cohort of 36 patients with coronary arterial spasm were treated with diltiazem.
- Patients were followed for a mean of 17.5 months.
- Angina attack frequency and adverse effects were recorded.
Main Results:
- Diltiazem therapy reduced angina attacks by 94% (from 21.5 to 1.3 attacks/week).
- Daily doses of 240 or 360 mg were effective.
- Most patients tolerated the treatment well, with minimal adverse effects like mild pedal edema.
Conclusions:
- Diltiazem is highly effective for long-term prophylaxis and treatment of angina in patients with coronary spasm.
- The drug is well-tolerated, making it a valuable therapeutic option.
- Adjunctive therapy with isosorbide dinitrate may be needed for some patients to achieve complete pain relief.
Abstract:
The first 36 patients with coronary arterial spasm treated with diltiazem and followed up at the Stanford University Coronary Artery Spasm Clinic for 6 months or longer are described. There were 13 men and 23 women with a mean age of 50.2 years; the mean duration of angina was 36.1 months. All patients had angina at rest with a good or fail response to sublingual nitroglycerin. During a mean of 17.5 months of diltiazem therapy, the frequency of angina was reduced from a mean of 21.5 to 1.3 attacks/week. This 94 percent reduction in pain frequency occurred when either 240 or 360 mg of diltiazem was administered daily. Sixteen patients required the addition of isosorbide dinitrate to achieve a painfree state. Pain breakthrough occurred a mean of 1.7 times during the 17.5 month follow-up period but tended to be of short duration. Six patients had trace to 1+ pedal edema and no other adverse effects occurred. It is concluded that diltiazem is highly effective and well tolerated for the long-term prophylaxis and treatment of angina in patients with coronary spasm.