Effect of Amlodipine on the Progression of Atherosclerosis and the Occurrence of Clinical Events

TLDR

Angiographic studies suggest calcium channel blockers may prevent new coronary lesions and slow progression of minimal lesions. This trial sought to determine whether amlodipine slows early coronary atherosclerosis progression in patients with angiographically documented disease. In a 36‑month, multicenter, randomized, double‑masked, placebo‑controlled study of 825 patients, changes in coronary minimal diameters and carotid intima‑media thickness were measured and clinical events monitored. Amlodipine did not reduce coronary minimal diameter progression but significantly slowed carotid intima‑media thickness increase and was linked to fewer unstable angina episodes and revascularizations, while mortality and major cardiovascular events remained unchanged.

Abstract

The results of angiographic studies have suggested that calcium channel-blocking agents may prevent new coronary lesion formation, the progression of minimal lesions, or both.The Prospective Randomized Evaluation of the Vascular Effects of Norvasc Trial (PREVENT) was a multicenter, randomized, placebo-controlled, double-masked clinical trial designed to test whether amlodipine would slow the progression of early coronary atherosclerosis in 825 patients with angiographically documented coronary artery disease. The primary outcome was the average 36-month angiographic change in mean minimal diameters of segments with a baseline diameter stenosis of 30%. A secondary hypothesis was whether amlodipine would reduce the rate of atherosclerosis in the carotid arteries as assessed with B-mode ultrasonography, which measured intimal-medial thicknesses (IMT). The rates of clinical events were also monitored. The placebo and amlodipine groups had nearly identical average 36-month reductions in the minimal diameter: 0.084 versus 0.095 mm, respectively (P:=0.38). In contrast, amlodipine had a significant effect in slowing the 36-month progression of carotid artery atherosclerosis: the placebo group experienced a 0.033-mm increase in IMT, whereas there was a 0. 0126-mm decrease in the amlodipine group (P:=0.007). There was no treatment difference in the rates of all-cause mortality or major cardiovascular events, although amlodipine use was associated with fewer cases of unstable angina and coronary revascularization.Amlodipine has no demonstrable effect on angiographic progression of coronary atherosclerosis or the risk of major cardiovascular events but is associated with fewer hospitalizations for unstable angina and revascularization.