Treatment of coronary artery disease

Coronary heart diseaseCoronary artery disease (CAD) is also known as atherosclerotic heart disease, coronary heart disease or ischemic heart disease (IHD).

Treatment of patients with coronary artery disease is aimed at preventing death, myocardial infarction, reducing the symptoms of angina and myocardial ischemia. Expanding peripheral vessels, Norvasc reduces the afterload of the heart. Because the drug does not cause reflex tachycardia (because there is no activation of the sympathetic-adrenal system), energy consumption and myocardial oxygen demand decrease. The drug dilates coronary arteries and increases myocardial oxygen supply. Antianginal effect (decrease of the duration of angina attacks, the daily requirement for nitroglycerin), increased exercise tolerance, improved systolic and diastolic function of the heart, in the absence of inhibitory effect on sinus and atrio-ventricular node and the other elements of the conduction system of the heart make this medication one of the most important drugs in the treatment of angina. Amlodipine widens the main coronary arteries and arterioles (including ischemic myocardial areas) and prevents the development of coronary artery spasm. Thus, the drug improves myocardial oxygen supply while reducing the need for it.

The CAPE study has shown that amlodipine added to the basic treatment of patients with angina, anginal attacks and prevents myocardial ischemia for 24 hours in the international double-blind, placebo-controlled CAPE II study, which lasted 8 weeks, Included 315 patients stable angina and Norvasc® (amlodipine) at a dose of 5-10 mg /day or placebo. 65% of patients in this study prior to the administration of amlodipine (Norvasc ®) already were given b-blockers. It has been shown that reception of amlodipine (Norvasc ®) once daily is accompanied by a decrease in the frequency of angina attacks during 24 hours in the treatment with amlodipine noted an increase in physical activity significantly more patients (75%) than with placebo (59%, p = 0.003). The drug significantly reduced the frequency of episodes of ischemic ST-segment depression on ECG, Holter monitoring, and the frequency of pain attacks and the need for short-nitrates. Only 2.0% of patients stopped the treatment with amlodipine (Norvasc) due to adverse effects, while on placebo – 4.4%.

In a double-blind, placebo-controlled study in 585 CAPARES patients undergoing angioplasty of the coronary arteries administered amlodipine 10 mg/daily for 2 weeks prior to and for 4 months after the intervention. While amlodipine therapy did not affect the development of restenosis then angioplasties of arteries (28.1% restenosis politically coded construct amlodipine and 28.4% in the placebo group), it reduced the risk of death on 35%. Thus, in patients with coronary atherosclerosis amlodipine showed better clinical results even in short duration of treatment (4 months.) That does not exclude the presence of the drug have not only antianginal, anti-ischemic, but anti-atherogenic effects.

The study PREVENT, which main purpose was to evaluate the influence of amlodipine (treatment duration 3 years) in the progression of atherosclerosis in the carotid and coronary arteries in 825 patients with CHD was found that amlodipine significantly slowed down the development of atherosclerosis in the carotid arteries compared with the placebo group. Effect on the dynamics of coronary lesions was invalid according to quantitative coronary angiography. When comparing the results of clinical indicators such as total mortality, fatal and nonfatal MI, the total number of coronary events was 31% lower (p = 0.01), which proves beneficial clinical effects of amlodipine. There was a decrease in the number of hospitalizations due to destabilization of angina pectoris and congestive heart failure (61 in the amlodipine group and 88 in the placebo group). Also amlodipine group observed reduction in the number of myocardial revascularization (53 versus 85 in the placebo group), regardless of the application of b-blockers, nitrates or lipid-lowering therapy. Frequency of anginal attacks decreased from 85 to 60.