Loaldi A, Polese A, Montorsi P, De Cesare N, Fabbiocchi F, Ravagnani P, Guazzi M D
Istituto di Cardiologia, University of Milan, Italy.
Am J Cardiol. 1989 Sep 1;64(8):433-9. doi: 10.1016/0002-9149(89)90417-7.
Calcium antagonists and beta blockers may retard or inhibit atherogenesis. This study investigated whether nifedipine or propranolol influences coronary atherosclerosis in humans. In selected patients with effort angina and proven coronary artery disease, the cineangiographic pattern after 2-year therapy with nifedipine (group 1, 39 patients), propranolol (group 2, 36 patients) or isosorbide dinitrate (group 3, 38 patients) was compared to that before treatment. The disease evolved to a different extent in the 3 groups. Patients with evidence of progression of old narrowings and appearance of new narrowings were significantly fewer in group 1 (31% and 10%) than in group 2 (53% and 34%) and group 3 (47% and 29%). The number of stenoses with evidence of progression was significantly smaller after nifedipine (14), and larger after propranolol (39) compared with group 3 (24). Thus, nifedipine seemed more protective than the other 2 drugs against coronary atherosclerosis. The coronary risk factors were normal in the nifedipine group and remained so with treatment, suggesting that they were dissociated from influences on atherosclerosis. The evolution, as judged by the number of narrowings with progression, appeared significantly (p less than 0.01) worse with propranolol than with isosorbide dinitrate. Propranolol caused unfavorable modifications of serum lipids; there was a 28% increase in total triglycerides and a 25% decrease in high density lipoprotein cholesterol at 12 months in group 2.
钙拮抗剂和β受体阻滞剂可能延缓或抑制动脉粥样硬化的形成。本研究调查了硝苯地平或普萘洛尔是否会影响人类冠状动脉粥样硬化。在选定的劳力性心绞痛且冠状动脉疾病确诊的患者中，将接受硝苯地平治疗2年的患者（第1组，39例）、普萘洛尔治疗2年的患者（第2组，36例）或硝酸异山梨酯治疗2年的患者（第3组，38例）的血管造影图像与治疗前进行比较。3组疾病进展程度不同。第1组中出现旧狭窄进展和新狭窄的患者比例（分别为31%和10%）明显低于第2组（分别为53%和34%）和第3组（分别为47%和29%）。与第3组（24例）相比，硝苯地平治疗后有进展证据的狭窄数量明显更少（14例），而普萘洛尔治疗后更多（39例）。因此，硝苯地平在预防冠状动脉粥样硬化方面似乎比其他两种药物更具保护作用。硝苯地平组的冠状动脉危险因素正常，且治疗后保持不变，这表明这些因素与对动脉粥样硬化的影响无关。从有进展的狭窄数量判断，普萘洛尔治疗后的病情进展明显（p<0.01）比硝酸异山梨酯更差。普萘洛尔导致血脂出现不良变化；第2组在12个月时总甘油三酯增加28%，高密度脂蛋白胆固醇降低25%。
