Key result
In patients with stable coronary artery disease, the use of calcium channel blockers was independently associated with a 1.72-fold increased odds of high on-aspirin platelet reactivity.
Why the study?
CCBs do not reduce the risk of initial or recurrent MI in stable CAD, prompting this study to evaluate the association between CCBs and aspirin resistance.
Does the use of calcium channel blockers increase aspirin resistance in patients with stable coronary artery disease?
Observational (n=503)
No
Does the use of calcium channel blockers increase aspirin resistance in patients with stable coronary artery disease?
Odds Ratio: 1.72 (95% CI 1.04–8.91)
Absolute Event Rate: 15.9% vs 7%
p-value: p=0.047
Concomitant use of calcium channel blockers in patients with stable coronary artery disease is associated with increased aspirin resistance, potentially attenuating the anti-thrombotic efficacy of aspirin.
CCB use was associated with aspirin resistance in stable CAD; hypothesis-generating and should not yet change practice.
Purpose: Calcium channel blockers (CCBs) do not reduce the risk of initial or recurrent myocardial infarction (MI) in patients diagnosed with stable coronary artery disease (CAD). The aim of this current study was to evaluate the association between CCBs and aspirin resistance in patients with CAD. Methods: Patients with stable CAD who were regularly taking aspirin (75-100 mg qd) for at least one month prior to enrollment in the study were included. The VerifyNow system was used for platelet function testing with high on-aspirin platelet reactivity (HAPR) defined as aspirin reaction units (ARU) >550. We compared patients treated with CCBs versus control group. Results: 503 patients with CAD were included in this study, 88 were treated with CCBs; Mean age (67.9±9.7 in the CCB group vs 66.5±11.4 in the control group, p=0.288), gender (77.3 male vs. 82.9%, p=0.214) and rates of diabetes mellitus (34.7 vs. 36.9%, p=.121) were similar. Rates of hypertension were higher in the CCB group (83.9 vs. 63.5%, p<0.01), but rates of past MI were lower (47.1 vs. 59.7%, p=0.039). The mean ARU was 465.4P70.0 for patients treated with CCBs versus 445.2u60.0 in controls (p=0.006). Similarly, 15.9% of CCB patients demonstrated HAPR compared to 7.0% (p=0.006). In a multivariate analysis, the administration of CCBs was independently associated with HAPR (OR- 1.72, 95% CI 1.04 – 8.91, p=0.047). Conclusions: Usage of CCBs is positively correlated with aspirin resistance. These findings may suggest an adverse pharmacologic effect of CCBs among patients with stable CAD treated with aspirin.
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Kodesh et al. (2021) conducted an observational in Stable coronary artery disease (n=503). Calcium channel blockers vs. No calcium channel blockers was evaluated on High on-aspirin platelet reactivity (HAPR) (OR 1.72, 95% CI 1.04-8.91, p=0.047). In patients with stable coronary artery disease, the use of calcium channel blockers was independently associated with a 1.72-fold increased odds of high on-aspirin platelet reactivity.
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