Calcium Antagonists for Secondary Prevention of Myocardial Infarction Is There a Need to Shift From Short-Acting to Long-Acting Types?

Abstract

ith their marked antianginal and blood pressure lowering effects, calcium antagonists have been widely used since the 1970s for the treatment of cardiovascular disease, particularly myocardial infarction (MI). 1 However, in 1984 the short-acting calcium antagonist nifedipine was shown to be ineffective for preventing MI; 2 indeed, a 1995 report showed that short-acting nifedipine actually increased the total mortality associated with MI when its daily dose reached 80 mg. 3 Similarly, a study carried out in Japan showed that short-acting nifedipine did not reduce the incidence of cardiac events among patients with a healed MI. 4 Finally, in 1999 the American Heart Association 5 and then researchers in Japan 6 announced that short-acting nifedipine was contraindicated for treatment of acute MI, and it was suggested that the cause of nifedipine's failure to improve the prognosis of MI was an increase in sympathetic nerve activity associated with the rapid reduction in blood pressure elicited by the drug. 7,8 But if a rapid decrease in the blood pressure was the cause of the problem, perhaps long-acting calcium antagonists, which reduce blood pressure slowly and are less likely to stimulate sympathetic nervous system activity, would more effectively prevent cardiac events following MI. The purpose of the present study, therefore, was to analyze retrospectively the effect of short-and long-acting calcium antagonists on the secondary prevention of MI and whether those drugs exert any preventative effect. MethodsWe retrospectively analyzed the effects of calcium antagonists on secondary prevention of MI in inpatients and outpatients treated at the Department of Cardiology, Kinki University School of Medicine. The subjects and methods of the study are described in detail in a previous report 4 and briefly below. Study Population and Inclusion CriteriaWe enrolled all patients (n=6,428) with MI treated in the Department during the study period, including those hospi- Methods and ResultsThe present study was a retrospective analysis of the incidences of cardiac events among patients with a healed MI treated with 3 times-a-day type nifedipine (half-life 1.8 h; n=617), twice-a-day type nifedipine (half-life 4.0 h; n=527) and those not taking calcium antagonists (n=1,593) from 1986 to 1993, and the incidences of those on once-a-day type calcium antagonists (half-life 11.0 h; n=903) and those not taking calcium antagonists (n=2,788) from 1994 to 2001. Cardiac events included cardiac death and nonfatal recurrent MI. Single and multivariate analyses using the Cox-Hazard model were performed. From 1986 to 1993 cardiac events occurred in 38 patients with 3-times-a-day nifedipine (6.2%, hazard ratio and 95% confidence interval: 1.45 and 0.93-2.27), in 18 patients with twice-a-day nifedipine (3.4%: 0.68 and 0.39-1.20), 57 patients without calcium antagonists (3.6%). Cardiac events also occurred in 11 patients with once-a-day type nifedipine (1.2%: 0.72 and 0.37-1.42) and 48 patients without calcium antagonists (1.7%). Of the once-a...

Impact of Long-Acting Calcium Channel Blockers on the Prognosis of Patients with Coronary Artery Disease with and without Chronic Kidney Disease: A Comparison of Three Drugs

“…7,8 In the present study, benidipine was shown to reduce the incidence of MACE in CAD patients. According to the Japan Multicenter Investigation for Cardiovascular Diseases B (JMIC-B) Study Group, long-acting dihydropyridine CCBs can improve the prognosis in CAD patients, 17 particularly those with underlying hypertension. 5 One study in Japanese patients demonstrated a beneficial effect of benidipine on survival after myocardial infarction compared with the effects of short-acting nisoldipine and nifedipine.…”