Thirty-Six Month Observation of 33 Coronary Vasospastic Angina(VSA) Patients Undergoing a Combination Therapy With a Calcium Channel Antagonist and a Statin : Clinical Evaluation With an Emphasis on the Etiology of Refractory VSA

Shimane journal of medical science Volume 28 Issue 2 Page 95-106 published_at 2012-02-01
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Title
Thirty-Six Month Observation of 33 Coronary Vasospastic Angina(VSA) Patients Undergoing a Combination Therapy With a Calcium Channel Antagonist and a Statin : Clinical Evaluation With an Emphasis on the Etiology of Refractory VSA
Creator
Nagami Haruhiko
Shirota Kinya
Shiode Nobuo
Source Title
Shimane journal of medical science
Volume 28
Issue 2
Start Page 95
End Page 106
Journal Identifire
ISSN 03865959
EISSN 24332410
Descriptions
Combination therapy with a calcium channel antagonist, such as benidipine hydrochrolide, and a HMG-CoA reductase inhibitor, such as pravastatin, which can improve lipid metabolism and reduce oxidative stress, may attenuate coronary vasoconstriction in patients with coronary spastic angina(VSA). The present study enrolled 33 patients with positive findings of the acethylcholine provocation test without coronary organic lesions in whom coronary angiography revealed no significant organic stenosis. In these patients, benidipine hydrochrolide or diltiazem hydrochrolide and an HMG-CoA reductase inhibitor(mainly pravastatin) were administered for 36 months following the acechylechline rovocation test. The total serum cholesterol level, serum HDL cholesterol level, and serum LDL cholesterol level were evaluated at the baseline, 6, 12, and 36 months after the treatment started.
The mean blood pressure was also measured at the baseline, 6, 12, and 36 months. Of 33 patients, refractory VSA were recognized in seven. In evaluating these seven patients, the lipid profile and mean blood pressure were within normal limits. However, it was demonstrated that 6 of 7 of these patients were habitual smokers and alcohol drinkers.
Accordingly, to prevent refractory attacks of VSA, the patients were required to cease consuming cigarettes and alcohol to prevent refractory VSA attacks. These results indicated that the results indicate that lifestyle modification is an extremely important factor, as is the drug administration of calcium channel antagonists and HMB-CoA reductase inhibitors in preventing refractory VSA attacks. The present results show that the relaxation of coronary vessels as a result of a calcium channel antagonist in addition to the improvement of the lipid metabolism, especially increasing the HDL cholesterol level, and reduction of the LDL cholesterol level, might inhibit vascular contractility. The precise mechanism of the inhibition of recurrent VSA by benidipine hydrochrolide and statin was not clearly identified in the present study. However, there was a very strong association between cigarette smoking and a pure coronary spasm.
In summary, a decrease of serum LDL cholesterol, an increase in serum HDL cholesterol, and an improvement in lifestyle habits, including the cessation of smoking, might be effective in inhibiting refractory VSA during treatment with calcium channel antagonists and statins.
Language
eng
Resource Type departmental bulletin paper
Publisher
Shimane University Faculty of Medicine
Date of Issued 2012-02-01
Publish Type Version of Record
Access Rights open access
Relation
[NCID] AA00841586
Remark http://ci.nii.ac.jp/vol_issue/nels/AA00841586_jp.html