Michels K B, Rosner B A, Manson J E, Stampfer M J, Walker A M, Willett W C, Hennekens C H
Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Mass 02115 USA.
Circulation. 1998 Apr 28;97(16):1540-8. doi: 10.1161/01.cir.97.16.1540.
In several observational studies, patients prescribed calcium channel blockers had higher risks of cardiovascular diseases and mortality than those prescribed other antihypertensive medications. We explored these associations in the Nurses' Health Study.
A total of 14 617 women who reported hypertension and regular use of diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, or a combination in 1988 were included in the analyses. Cardiovascular events and deaths were ascertained through May 1, 1994. We documented 234 cases of myocardial infarction. Calcium channel blocker monodrug users had an age-adjusted relative risk (RR) of myocardial infarction of 2.36 (95% CI, 1.43 to 3.91) compared with those prescribed thiazide diuretics. Women prescribed calcium channel blockers had a higher prevalence of ischemic heart disease. After adjustment for these and other coronary risk factors, the RR was 1.64 (95% CI, 0.97 to 2.77). Comparing the use of any calcium channel blocker (monodrug and multidrug users) with that of any other antihypertensive agent, the adjusted RR was 1.42 (95% CI, 1.01 to 2.01). An association between calcium channel blocker use and myocardial infarction was apparent among women who had ever smoked cigarettes (covariate-adjusted RR, 1.81; 95% CI, 1.20 to 2.72) but not among never-smokers (RR, 0.94; 95% CI, 0.48 to 1.84).
In analyses adjusted only for age, we found a significant elevation in RR of total myocardial infarction among women who used calcium channel blockers compared with those who did not. After adjustment for comorbidity and other covariates, the RR was reduced. Whether the remaining observed elevated risk is real, or a result of residual confounding by indication, or chance, or a combination of the above cannot be evaluated with certainty on the basis of these observational data.
在多项观察性研究中，服用钙通道阻滞剂的患者比服用其他抗高血压药物的患者患心血管疾病和死亡的风险更高。我们在护士健康研究中探讨了这些关联。
分析纳入了1988年报告患有高血压且经常使用利尿剂、β受体阻滞剂、钙通道阻滞剂、血管紧张素转换酶抑制剂或联合用药的14617名女性。心血管事件和死亡情况确定至1994年5月1日。我们记录了234例心肌梗死病例。与服用噻嗪类利尿剂的女性相比，单纯使用钙通道阻滞剂的女性经年龄调整后的心肌梗死相对风险（RR）为2.36（95%CI，1.43至3.91）。服用钙通道阻滞剂的女性缺血性心脏病患病率更高。在对这些及其他冠状动脉危险因素进行调整后，RR为1.64（95%CI，0.97至2.77）。将任何钙通道阻滞剂（单纯用药和联合用药者）的使用情况与任何其他抗高血压药物的使用情况进行比较，调整后的RR为1.42（95%CI，1.01至2.01）。在曾经吸烟的女性中，使用钙通道阻滞剂与心肌梗死之间的关联明显（协变量调整后的RR，1.81；95%CI，1.20至2.72），而在从不吸烟的女性中则不明显（RR，0.94；95%CI，0.48至1.84）。
在仅针对年龄进行调整的分析中，我们发现与未使用钙通道阻滞剂的女性相比，使用钙通道阻滞剂的女性总的心肌梗死RR显著升高。在对合并症和其他协变量进行调整后，RR有所降低。基于这些观察性数据，无法确定剩余观察到的风险升高是真实的，还是因适应证残留混杂、偶然因素或上述因素共同作用所致。
