Circulation, Vol 82, 1940-1953, Copyright © 1990 by American Heart Association
D Waters, J Lesperance, M Francetich, D Causey, P Theroux, YK Chiang, G Hudon, L Lemarbre, M Reitman and M Joyal
To determine whether calcium channel blockers influence the progression of
coronary atherosclerosis, 383 patients age 65 years or less with 5- 75%
stenoses in at least four coronary artery segments were selected at random
within 1 month of coronary arteriography to participate in double-blind
therapy with a placebo or nicardipine 30 mg three times daily. Coronary
events (5 deaths, 22 myocardial infarctions, and 28 unstable anginas)
occurred in 28 of 192 nicardipine patients and 23 of 191 placebo patients
(p = NS). At 24 months coronary arteriography was repeated in 335 patients.
Progression, defined as a 10% or more worsening in diameter stenosis,
measured quantitatively, was found in 147 of 1,153 lesions (12.7%) in 168
nicardipine patients and in 170 of 1,170 lesions (14.5%) in 167 placebo
patients (p = NS). Ninety-two nicardipine patients (55%) and 95 placebo
patients (57%) had progression at one or more sites (p = NS). Regression,
that is, an improvement by 10% or more in diameter stenosis, was seen in
140 of 2,323 lesions (6.0%) overall, with no significant intergroup
difference. Among the 217 patients with 411 stenoses of 20% or less in the
first study, such minimal lesions progressed in only 15 of 99 nicardipine
patients compared with 32 of 118 placebo patients (15% versus 27%, p =
0.046). In this subgroup, 16 of 178 minimal lesions in nicardipine patients
and 38 of 233 minimal lesions in placebo patients progressed (p = 0.038).
By stepwise logistic-regression analysis, baseline systolic blood pressure
(p = 0.04) and the change in systolic blood pressure between baseline and 6
months (p = 0.002) correlated with progression of minimal lesions. This
suggested blood pressure reduction may account for the beneficial action of
nicardipine. These results suggested nicardipine has no effect on advanced
coronary atherosclerosis but may retard the progression of minimal lesions.
ARTICLES
A controlled clinical trial to assess the effect of a calcium channel blocker on the progression of coronary atherosclerosis
Department of Medicine, Montreal Heart Institute, Quebec, Canada.
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