Bangalore Sripal, Parkar Sanobar, Messerli Franz H
Department of Medicine, Division of Cardiology, St. Luke's Roosevelt Hospital and Columbia University College of Physicians and Surgeons, New York, NY 10019, USA.
Am J Med. 2009 Apr;122(4):356-65. doi: 10.1016/j.amjmed.2008.09.043.
The use of calcium channel blockers (CCBs) in patients with coronary artery disease remains controversial, with reports of increased risk of myocardial infarction and all-cause mortality. Short-acting CCBs have an unfavorable hemodynamic profile. The role of long-acting CCBs in patients with coronary artery disease is unknown.
MEDLINE/CENTRAL/EMBASE database were searched from 1966 to August 2008 for randomized controlled trials of long-acting CCBs in patients with coronary artery disease with follow-up for at least 1 year. We extracted from the studies the baseline characteristics and 6 outcomes: all-cause mortality, cardiovascular mortality, nonfatal myocardial infarction, stroke, angina pectoris, and heart failure.
Of the 100 randomized controlled trials of CCBs in patients with coronary artery disease, 15 studies evaluating 47,694 patients fulfilled our inclusion criteria. When compared with the comparison group (including placebo), CCBs were not associated with an increased risk of all-cause mortality (relative risk [RR] 0.99; 95% confidence interval [CI], 0.94-1.05), cardiovascular mortality (RR 1.03; 95% CI, 0.95-1.11), nonfatal myocardial infarction (RR 0.96; 95% CI, 0.87-1.06), or heart failure (RR 0.86; 95% CI, 0.71-1.05), and with a 21% reduction in the risk of stroke (95% CI, 0.70-0.89) and 18% reduction in the risk of angina pectoris (95% CI, 0.72-0.94). When compared with placebo, CCBs resulted in a 28% reduction in the risk of heart failure (95% CI, 0.73-0.92). The results were similar for both dihydropyridines and nondihydropyridine CCBs.
In patients with coronary artery disease, long-acting CCBs (either dihydropyridines or nondihydropyridines), were associated with a reduction in the risk of stroke, angina pectoris, and heart failure, with similar outcomes for other cardiovascular events as the comparison group.
钙通道阻滞剂（CCB）在冠状动脉疾病患者中的应用仍存在争议，有报道称其会增加心肌梗死风险和全因死亡率。短效CCB具有不良的血流动力学特征。长效CCB在冠状动脉疾病患者中的作用尚不清楚。
检索MEDLINE/CENTRAL/EMBASE数据库1966年至2008年8月间关于长效CCB用于冠状动脉疾病患者且随访至少1年的随机对照试验。我们从这些研究中提取了基线特征和6项结局指标：全因死亡率、心血管死亡率、非致死性心肌梗死、中风、心绞痛和心力衰竭。
在100项关于CCB用于冠状动脉疾病患者的随机对照试验中，15项评估47694例患者的研究符合我们的纳入标准。与对照组（包括安慰剂）相比，CCB与全因死亡率增加风险无关（相对危险度[RR]0.99；95%置信区间[CI]，0.94 - 1.05）、心血管死亡率（RR 1.03；95% CI，0.95 - 1.11）、非致死性心肌梗死（RR 0.96；95% CI，0.87 - 1.06）或心力衰竭（RR 0.86；95% CI，0.71 - 1.05），且中风风险降低21%（95% CI，0.70 - 0.89），心绞痛风险降低18%（95% CI，0.72 - 0.94）。与安慰剂相比，CCB使心力衰竭风险降低28%（95% CI，0.73 - 0.92）。二氢吡啶类和非二氢吡啶类CCB的结果相似。
在冠状动脉疾病患者中，长效CCB（二氢吡啶类或非二氢吡啶类）与中风、心绞痛和心力衰竭风险降低相关，其他心血管事件的结局与对照组相似。
