Calcium channel blockers: association with myocardial infarction, mortality, and cancer

The purpose of this study was to review the results of trials assessing the association between the use of calcium channel blockers (CCBs) and mortality, myocardial infarction (MI), and cancer. Possible mechanisms of such relationships are discussed and recommendations regarding the use of CCBs made. Since 1995, 10 controversial studies have been published that associate the use of CCBs with an increased risk of mortality, MI, and cancer; these findings have caused widespread anxiety and frustration among patients and physicians. For health care professionals to properly advise patients, the facts surrounding this controversy should be reviewed. To do this, we reviewed and assessed English-language clinical studies, abstracts, editorials, and review articles pertaining to the use of CCBs and mortality, MI, and cancer in humans. The designs of ongoing prospective, randomized studies are discussed. Based on current published studies, the US Food and Drug Administration has agreed to a label warning against off-label use of short-acting nifedipine in patients with hypertension, acute MI, or nonvasospastic unstable angina. Practitioners should exercise caution when prescribing CCBs, especially to high-risk patients (e.g., those with congestive heart failure or clinical or subclinical coronary artery disease). When possible, long-acting CCBs should be used.