THE CALCIUM-ANTAGONIST CONTROVERSY - A POSTHUMOUS COMMENTARY

In 1995, some retrospective reports showed that certain patients treat ed with short-acting calcium antagonists were at increased risk for my ocardial infarction and had a higher mortality rate compared with pati ents treated with other cardiovascular drugs. Subsequent reports attem pted to establish a connection between calcium antagonists and disorde rs as diverse as malignancy, Parkinsonism, cognitive dysfunction, and suicide. However, other retrospective studies and, more compelling, se veral prospective studies have reported that calcium antagonists exert a beneficial effect on morbidity and mortality in a variety of cardio vascular disorders such as hypertension, ischemic heart disease after myocardial infarction, and congestive heart failure due to dilated car diomyopathy. Calcium antagonists are a heterogeneous drug class, and d istinct differences have been documented between short- and long-actin g, as well as between dihydropyridine and nondihydropyridine, agents. Sympathetic activation, which is a risk factor for coronary events, oc curs with short-acting agents only and is absent with long-acting calc ium antagonists. Recent dam make it extremely unlikely that calcium an tagonists increase the risk of malignancy by affecting apoptosis or im munosuppression or both. Long-acting calcium antagonists have distinct benefits in patients with hypertension and diabetes and may be more b eneficial than other drugs in patients with diabetes and left ventricu lar hypertrophy. (C) 1998 by Excerpta Medico, Inc.