Management of Coronary Heart Disease Risk Factors and Progression with Calcium Channel Blockers

The death rate from coronary heart disease (CHD) declined by 25% in the United States during 1987-1997, but the actual number of deaths fell by only 9%. Modifiable risk factors for CHD include hypertension, elevated low-density lipoprotein cholesterol, reduced high-density lipoprotein cholesterol, cigarette smoking, and diabetes. Several randomized clinical trials demonstrated that calcium channel blockers reduce the frequency of strokes in patients with hypertension, with particular benefit observed in patients with both hypertension and diabetes. Results of a meta-analysis suggest that calcium channel blockers are similar to beta-blockers in preventing death or myocardial infarction and in improving exercise tolerance among patients with established CHD. In addition, amlodipine, a long-acting dihydropyridine, was reported to reduce nonfatal vascular events and major vascular procedures in patients with angina. Ongoing clinical trials are comparing amlodipine with an angiotensin-converting enzyme inhibitor for slowing the onset and progression of coronary artery plaque and cardiovascular events.