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[Calcium antagonists in the secondary prevention of myocardial infarction]
Insights
Calcium antagonists like nifedipine showed no benefit for secondary myocardial infarction prevention. Diltiazem or verapamil may offer an alternative to beta-blockers, but do not reduce mortality.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Clinical Trials
Context:
- Secondary prevention of myocardial infarction (MI) is crucial for patient outcomes.
- Calcium antagonist drugs are used in cardiovascular disease management.
- Assessing the efficacy and safety of these drugs in post-MI patients is essential.
Purpose:
- To conduct a meta-analysis evaluating calcium antagonist drugs for secondary MI prevention.
- To determine the impact of nifedipine, diltiazem, and verapamil on mortality and reinfarction risk.
Summary:
- Meta-analysis of trials involving 9,033 patients for nifedipine and 8,356 for diltiazem/verapamil.
- Nifedipine showed a non-significant increase in total mortality and no change in reinfarction risk.
- Diltiazem or verapamil did not significantly alter total mortality but decreased reinfarction risk by 21% (p=0.009).
Impact:
- Nifedipine demonstrates no benefit in secondary MI prevention.
- Diltiazem or verapamil may serve as alternatives to beta-blockers when contraindicated.
- These drugs do not offer a mortality benefit in the secondary prevention of MI.
Abstract:
We performed a meta-analysis on data from trials of calcium antagonist drugs in the secondary prevention of myocardial infarction. Nifedipine (9,033 patients) increased total mortality non significantly by 12% at the end of follow-up, and by 62% (p = 0.02) before 21 days, with no significant change in the risk of reinfarction. Diltiazem or verapamil did not change total mortality significantly; each of them decreased the risk of reinfarction not significantly (p = 0.06) by approximately 20%. Treatment by either diltiazem or verapamil (8,356 patients) decreased the risk of reinfarction by 21% (p = 0.009). No benefit has been demonstrated with nifedipine in the secondary prevention of myocardial infarction. Verapamil or diltiazem may be an alternative to beta-blockers when these lasts drugs are contra-indicated, although one cannot reasonably expect from the first two drugs a decrease in mortality.