Prognostic Effects of Calcium Channel Blockers in Patients With Vasospastic Angina - A Meta-Analysis -

Abstract

Background: Although calcium channel blockers (CCB) are highly effective for suppression of vasospastic angina (VSA) attacks, their prognostic effects in VSA patients remain to be examined in a large number of patients. Methods and Results:Databases for related papers were searched and then a meta-analysis regarding the effects of CCB on major adverse cardiovascular events (MACE) in Japanese VSA patients with the 4 previous studies was performed. A total of 1,997 patients with positive coronary spasm provocation tests were evaluated. They were treated with either alone or combination of benidipine (n=320), amlodipine (n=308), nifedipine (n=182) or diltiazem (n=960). MACE were observed in 143 patients (cardiac death: 36, myocardial infarction: 51, heart failure: 26, stroke: 65, and aortic aneurysm: 11). The hazard ratio for the occurrence of MACE was significantly lower in patients treated with benidipine than in those with diltiazem. There was no significant difference in the clinical characteristics affecting the occurrence of MACE among the 4 CCB groups. Furthermore, the hazard ratio for the occurrence of MACE was significantly lower in those treated with benidipine, even after correction for patient characteristics that could have affected the occurrence of MACE (hazard ratio 0.41, P=0.016). Conclusions:These results suggest that among the 4 major CCB that effectively suppress VSA attacks in general, benidipine showed significantly more beneficial prognostic effects than others. (Circ J 2010; 74: 1943 - 1950 Methods Study Eligibility Criteria and Search StrategyWe searched the database of MEDLINE ® for papers published in English from 1950 to December, 2008 and the Japana Centra Revuo Medicina (Ichushi ® ) for papers published in Japanese with an English abstract from 1983 to December, 2008. The keywords used were 16 CCB (nifedipine, nicardipine, nisoldipine, nitrendipine, nilvadipine, manidipine, benidipine, amlodipine, barnidipine, efonidipine, felodipine, clinidipine, aranidipine, azelnidipine, diltiazem, or verapamil), prognosis, and VSA and related terms (vasospasm, coronary VSA, rest angina, variant angina). The papers in Japanese were restricted to those with an English abstract. Among the 11,636 papers in English searched by the database of MEDLINE ® , 2 papers were finally selected, in which the effects of CCB on the occurrence of MACE in VSA patients were compared ( Figure 1A). 10,11 In addition, 2 papers in Japanese were selected 12,13 among the 6,315 papers searched

Effects of Calcium-Channel Blocker Benidipine-Based Combination Therapy on Cardiac Events ― Subanalysis of the COPE Trial ―

“…However, it is possible that the long-acting CCB benidipine-based treatment in the COPE trial would result in little difference in cardiac ischemic events between the β-blocker group and the other 2 groups, because benidipine is beneficial for preventing cardiac events caused by vasospastic angina. 13 Further studies are required to confirm the results of this study of the secondary prevention of patients with hypertension and coronary artery disease.…”

“…15 In addition, no apparent differences were observed in concomitant medication usage, such as antiplatelets, lipid-lowering drugs, ment effects than the others. 13 The Combination Therapy of Hypertension to Prevent Cardiovascular Events (COPE) trial is the first clinical trial to examine benidipine-combination therapy for the treatment of hypertension in Japan. 14, 15 The trial results demonstrated that both the percentages of subjects achieving the target blood pressure (BP) and the incidences of primary composite cardiovascular endpoints were similar among the benidipine-thiazide diuretic (thiazide), benidipineangiotensin-receptor blocker (ARB), and benidipine-β-blocker groups.…”

The Who, What, Why, When, How and Where of Vasospastic Angina

“…These agents have been shown to reduce symptomatic angina episodes, 56-62 suppress inducible coronary spasm, 60 and most importantly are an independent determinant of preventing MACE in vasospastic angina patients. 33, 63 Nitrates have been used since the first description of vasospastic angina and are effective in reducing anginal episodes, 57 although their efficacy in reducing MACE is not evident. 64, 65 Nicorandil is a potassium-channel opener with nitrate-like effects that is extensively used in Japan for the treatment of vasospastic angina.…”

Effects of the T/L-type Calcium Channel Blocker Benidipine on Albuminuria and Plasma Aldosterone Concentration

“…[35][36][37][38] From now on, it seems important to select drugs by considering the class effects of CCB on the inhibition of cardiovascular accidents. Study limitations: First, it should be remembered that the current study adopted a switchover design and did not carefully investigate potential differences between different drugs (Ltype CCBs, T-type CCB).…”