The effect of amlodipine on endothelial function in young adults with a strong family history of premature coronary artery disease: a randomised double blind study

Endothelial dysfunction, an early event in atherogenesis, has been demonstr ated in young asymptomatic subjects with a strong family history of prematu re coronary artery disease (CAD). In these subjects, preventive measures in volving risk factor modification are not appropriate, and strategies employ ing novel antiatherogenic agents, such as the dihydropyridine calcium chann el blocker, amlodipine, may be useful. Ninety-one subjects (mean age, 28.6 years; range, 18-40) with a strong family history of premature CAD and no o ther identified vascular risk factors were randomised to either 5 mg amlodi pine (49 subjects) or placebo (42 subjects). Brachial artery flow mediated dilatation (FMD) (endothelium-dependent response) and response to glycerylt rinitrate (GTN) (direct smooth muscle dilator) were assessed non-invasively at baseline, and after 12 and 24 weeks using high-resolution vascular ultr asound. In those treated with amlodipine, mean FMD increased from 2.32 +/- 2.23% at baseline to 3.52 +/- 3.1% at 24 weeks (P < 0.005). However, FMD al so increased in the placebo group from 1.64 <plus/minus> 2.12 to 3.37 +/- 2 .68% (P < 0.002), and the difference between the FMD response in the amlodi pine and placebo groups was not significant. Dilatation to GTN did not chan ge in either group. Therefore, impaired endothelial function improved in fa mily history subjects taking both amlodipine and placebo, but there is no d ifference between the groups. (C) 2001 Elsevier Science Ireland Ltd. All ri ghts reserved.