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

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.