Tracking Coronary Calcification and Atherosclerotic Lesions in Patients with Stable Angina Pectoris Undergoing Nifedipine Therapy

Abstract

Aims: The objective of the Coronary Calcification (CC) study was to determine in patients with chronic symptomatic coronary artery disease, if, in addition to standard therapy, nifedipine GITS, relative to placebo, would arrest or slow down the progression of calcium or the development of new atherosclerotic lesions in the coronary arteries. Methods and Results: The CC study was part of the ACTION trial. Multi-slice computerized tomography was used to measure and track the progression of CC. Five hundred and eighteen patients were included in this study. The changes in calcium score from baseline every 24 months, over a period of between 4.5 and 6 years, were similar in the nifedipine and placebotreatment groups (p = 0.8). Compared to placebo, more patients in the nifedipine group (71 vs. 60%) were free of new calcified atherosclerotic lesions during follow-up(p = 0.095). Conclusion: Nifedipine GITS was not effective in slowing down the progression of calcium in advanced atherosclerotic plaques in patients with stable angina pectoris. Although statistically not significant, Nifedipine demonstrated a trend in slowing down the development of new atherosclerotic lesions.

Long-term changes in serum cholesterol level does not influence the progression of coronary calcification

“…This technique has since been replaced by the use of faster electrocardiographically gated multi-detector row spiral techniques with higher reproducibility and accuracy. However, the clinical accuracy of the nongated procedure, its reproducibility, and its usefulness in tracking the progression of calcific coronary atherosclerosis has been shown to be adequate [8,21,[39][40][41][42].…”

“…A detailed description of the ACTION design and results has been published previously [19][20][21]. LLT was either continued or started according to local guidelines.…”

Abdominal aortic calcification: from ancient friend to modern foe

“…74,75 Some small clinical trials have confirmed these results in the coronary arteries in humans. In placebo-controlled trials, nifedipine was shown to reduce the number of newly formed coronary lesions in early stage coronary artery disease, 76 but not instable angina pectoris, 77 and to slow down coronary artery calcification when compared to co-amizolide in patients with hypertension. 78 Azelnidipine compared to the diuretic indapamide was shown to improve arterial stiffness in patients with hypertension.…”

Calcium channel regulation in vascular smooth muscle cells: Synergistic effects of statins and calcium channel blockers

“…More recently, in the Cardiovascular Events in Patients With Coronary Disease and Normal Blood Pressure (CAMELOT) study [38], amlodipine (which was compared with placebo and enalapril) was reported to reduce cardiovascular events compared with placebo but had no significant effect on plaque atheroma volume measured by intravascular ultrasound. In the recent Coronary Calcification (CC) trial no effect of nifedipine was observed with respect to progression of coronary calcification assessed by multi-slice computerized tomography, although there was a trend suggesting a reduction in new lesions [39]. A number of early studies failed to show beneficial effects of CCB on restenosis rates following coronary angioplasty [40,41], although Hoberg et al reported that verapamil reduced restenosis [42].…”