Behar S
Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel.
Cardiovasc Drugs Ther. 1998 Apr;12 Suppl 1:119-24. doi: 10.1023/a:1007785328325.
This study was designed to investigate the association of calcium channel blocker (CCB) use with subsequent mortality in a group of patients with chronic stable angina. CCBs have been proven effective in the treatment of angina pectoris. Recently, the safety of CCBs in hypertensive and coronary artery disease patients has been challenged. New prospective controlled studies with nifedipine are under way that may help define the long-term safety of CCBs in the treatment of these patients. Until these studies are concluded, long-term data on mortality among CCB users may be informative. From 1990 to 1992, 11,575 patients with coronary heart disease were screened but not included in a secondary prevention study with bezafibrate conducted in 18 cardiac departments in Israel. Of these patients, 2390 had chronic angina without a history of myocardial infarction and were followed for subsequent mortality over 4-6 years (mean 5.2 years). From this patient population, 1366 (57%) reported receiving a CCB. They included more women and hypertensives, and a greater proportion of them exhibited a higher severity of anginal class than counterparts not treated with a CCB (n = 1024). The mortality in patients treated with CCBs was similar to those not treated with CCBs (11.5% vs. 11.6%; P = 0.53). A multivariate analysis accounting for differences in age, sex, and other clinical parameters associated with increased risk evaluated the estimated hazard ratio (HR) of death of patients treated with CCBs compared with those not treated with CCBs (HR = 0.89; 95% CI = 0.68-1.16). In Cox regression analysis, the adjusted HR of death of patients treated with nifedipine or diltiazem, together with a beta-blocker, was 0.85 (95% CI = 0.47-1.54) and 0.47 (95% CI = 0.24-0.90), respectively. After a follow-up of 4-6 years (mean 5.2) there was no evidence of increased mortality risk associated with CCB use among coronary heart disease patients with chronic stable angina. However, due to wide confidence intervals and possible confounding factors, randomized control studies are required to provide definitive information.
本研究旨在调查一组慢性稳定型心绞痛患者使用钙通道阻滞剂（CCB）与随后死亡率之间的关联。CCB已被证明在治疗心绞痛方面有效。最近，CCB在高血压和冠状动脉疾病患者中的安全性受到了质疑。正在进行硝苯地平的新的前瞻性对照研究，这可能有助于确定CCB在治疗这些患者中的长期安全性。在这些研究得出结论之前，CCB使用者的死亡率长期数据可能会提供有用信息。1990年至1992年，对11575例冠心病患者进行了筛查，但未纳入在以色列18个心脏科进行的一项关于苯扎贝特的二级预防研究。在这些患者中，2390例患有慢性心绞痛且无心肌梗死病史，并随访了4至6年（平均5.2年）以观察随后的死亡率。在这些患者中，1366例（57%）报告接受了CCB治疗。他们中女性和高血压患者更多，并且与未接受CCB治疗的患者（n = 1024）相比，他们中更大比例的人心绞痛分级更严重。接受CCB治疗的患者死亡率与未接受CCB治疗的患者相似（11.5%对11.6%；P = 0.53）。一项考虑了年龄、性别和其他与风险增加相关的临床参数差异的多变量分析评估了接受CCB治疗的患者与未接受CCB治疗的患者相比的估计死亡风险比（HR）（HR = 0.89；95%可信区间 = 0.68 - 1.16）。在Cox回归分析中，接受硝苯地平或地尔硫䓬联合β受体阻滞剂治疗的患者调整后的死亡HR分别为0.85（95%可信区间 = 0.47 - 1.54）和0.47（95%可信区间 = 0.24 - 0.90）。在随访4至6年（平均5.2年）后，没有证据表明在患有慢性稳定型心绞痛的冠心病患者中使用CCB会增加死亡风险。然而，由于可信区间较宽以及可能存在的混杂因素，需要进行随机对照研究来提供确切信息。
