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Certain long-acting calcium channel blockers appear to improve outcomes in heart attack survivors, but more research is needed

Calcium channel blockers are used widely in patients with hypertension and coronary artery disease. Recent studies suggest that the short-acting form of these medications may cause adverse cardiovascular and other problems. This study, by researchers at Harvard Medical School, Harvard School of Public Health, and the University of California School of Medicine, San Francisco, shows that the long-acting form of one class of calcium channel blockers (dihydropyridines) compared with the short-acting form was associated with markedly lower rates of death and cardiac rehospitalization in older survivors of heart attack. Nevertheless, beta blockers and aspirin have proven effectiveness after heart attack and should be the first line of therapy in eligible patients, according to the researchers. Their work was supported in part by the Agency for Health Care Policy and Research (HS07631).

The researchers analyzed three databases from the State of New Jersey on hospital admissions for acute myocardial infarction (AMI, heart attack) and Medicare and drug claims data. They constructed a sample of Medicare patients who suffered AMI in 1989 and 1990, when both short-acting and long-acting channel blockers were in use. They then compared rehospitalization and death rates of older heart attack survivors who took short- versus long-acting dihydropyridines (chiefly nifedipine) and non-dihydropyridines (diltiazem and verapamil).

The long-acting form of dihydropyridine was associated with a 55 to 60 percent reduced risk of death over the 2 years of followup and a 40 to 45 percent reduced rate of rehospitalization for cardiovascular disease in older survivors of heart attack. The findings were less clear for the non-dihydropyridines. Although the data suggested a reduction in risk of cardiac rehospitalization, these agents did not reduce—and may possibly have increased—the risk of death. The researchers conclude that more studies are needed before firm recommendations can be made about the appropriate use of long-acting dihydropyridines, as well as to examine the effect of long-acting forms of non-dihydropyridines.

See "Effects of long-acting versus short-acting calcium channel blockers among older survivors of acute myocardial infarction," by Matthew W. Gillman, M.D., Dennis Ross-Degnan, Sc.D., Thomas J. McLaughlin, Sc.D., and others, in the May 1999 Journal of the American Geriatrics Society 47, pp. 1-6.

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