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PubMed1999

[Primary and secondary prevention of coronary heart disease: what can we afford?].

In secondary prevention, statins are cost-effective and even more cost-effective than other lipd lowering drugs. Statins are especially favorable in patients with previous myocardial infarction compared to those with angina pectoris. For secondary prevention of coronary heart disease, statins should be administered generously. In primary prevention, statins are effective but not cost-efficient. Unfavorable results have to be expected especially in premenopausal women, younger patients, and in those with a low risk factor profile. For population based primary prevention, only dietary measures can be advocated; however, apart from a serious lack of compliance their efficiency has not yet been proven. Preventive measures have their own prize; in general they are considered not to prevent coronary heart disease but retard it. Therefore, such therapeutic interventions can be assumed not to reduce but rather to increase the "direct" medical costs. Furthermore, successful prevention of coronary heart disease leads, due to life-prolongation, to an increase in people out of work and in disabled patients due to age and/or disease. Therefore, an increase especially of the "indirect" costs for unemployment, pension, nursing homes, etc. must be expected.

Coronary Disease↗

PubMed1977

Echocardiographic patterns in scleroderma.

The echocardiograms of two patients with sclerodermatous cardiac disease are described. In one patient the pattern was that of a congestive cardiomyopathy with ventricular dilatation and reduced wall motion. In the second patient the pattern was that of an infiltrative cardiomyopathy with thickened walls and reduced wall motion in the absence of ventricular dilatation. Echocardiographic studies are useful in the early detection of pericardial involvement and primary or secondary myocardial involvement by scleroderma and in following the progression of the disease process.

Adult↗

PubMed1992

Anatomic features in victims of sudden coronary death. Coronary artery pathology.

Study of the detailed pathology of the myocardium and coronary arteries in ambulatory subjects dying suddenly of coronary heart disease shows that they can be divided into two groups. In one group, there is atherosclerosis with a new vascular event involving coronary thrombosis, which initiates acute myocardial ischemia. In the other group, there is chronic high-grade stenosis due to atherosclerosis, but there is no recent vascular change; the myocardium in this group shows scarring from a previously healed infarction acting as a substrate for reentrant ventricular arrhythmias. A study of 168 consecutive cases of sudden coronary death in London showed 73.3% to have had a recent coronary thrombotic lesion, giving a ratio of 2.7:1 for patients with versus patients without new acute myocardial ischemia. The widely differing ratios reported in the literature probably reflect the patterns of case selection. Prodromal pain immediately before the onset of ventricular fibrillation in a patient without previous known coronary disease selects for a thrombotic cause and acute myocardial ischemia. Absence of pain in a patient known to have had a previous infarction selects for a primary arrhythmia on the basis of preexisting myocardial hypertrophy and/or scarring.

Acute Disease↗

PubMed2002

[Long-term risk of stroke after acute myocardial infarction].

PURPOSE: To examine the incidence of stroke during the first three years after a first-ever myocardial infarction. MATERIAL AND METHODS: Both Kaunas community-based ischemic heart disease register and stroke register were used as the primary source of data. The methods used for data collection were those applied by the WHO for the international MONICA project. During 1986 to 1996, 4201 persons aged 25 to 61 years with a first-ever myocardial infarction were included into Kaunas community-based ischemic heart disease register and followed-up for three years against first-ever stroke or death from any cause. Actuarial life tables were used to analyze risk of stroke. RESULTS: During the study period, 82 (2.0%) patients with the first-ever stroke that occurred among survivors of myocardial infarction were identified: 68 (82.9%) men and 14 (17.1%) women. The cumulative risk of stroke was 3.19% (95% CI 2.50 to 3.88%) by 3 years: among male myocardial infarction survivors this risk was accounted for 3.37% (95% CI 2.54 to 4.17%) and that among female--for 2.51% (95% CI 1.22 to 3.80%). The risk was identified as the highest one early after ictus among the myocardial infarction survivors: 0.43% (95% CI 0.21-0.65%) by 3 months (men--0.51% (95% CI 0.24 to 0.78%), women--0.12% (95% CI 0 to 0.38%)) and 0.23% (95% CI 0.05 to 0.41%) by 6 months (men--0.25% (95% CI 0.03 to 0.47%), women--0.18% (95% CI 0 to 0.53%)). CONCLUSION: The risk of stroke is identified as the highest one early after the myocardial infarction.

Actuarial Analysis↗

PubMed1996

Postischemic functional recovery and BMIPP uptake after primary percutaneous transluminal coronary angioplasty in acute myocardial infarction.

To correlate asynergic wall motion after primary percutaneous transluminal coronary angioplasty with myocardial perfusion and fatty acid metabolism, quantitative tomographies using thallium and radioiodinated 15-(p-iodophenyl)-3-R,S-methylpentadecanoic acid (BMIPP) were performed during the acute and recovery stages in 56 consecutive patients with acute myocardial infarction, of whom 32 underwent primary percutaneous transluminal coronary angioplasty (group A) and 24 were conservatively treated (group B); 44 patients (79%) had 1-vessel disease. Reduced myocardial uptakes of thallium and BMIPP and regional wall motion were quantified with a bull's eye technique and a centerline method using contrast left ventriculography, respectively. BMIPP activity was significantly lower than that of thallium at an acute stage in both groups. Abnormal BMIPP activities and the difference in thallium and BMIPP abnormalities (perfusion metabolism mismatch) at an acute stage decreased significantly during follow-up in group A (111 +/- 13 to 99 +/- 12 and 30 +/- 10 to 15 +/- 10, respectively), and not in group B (129 +/- 31 vs 118 +/- 29 and 29 +/- 13 vs 30 +/- 10, respectively). Improvement in regional wall motion abnormality correlated closely with the improved uptakes of thallium and BMIPP (y = 0.64x + 26.4, r = 0.56, p < 0.05; y = 1.1x + 11.1, r = 0.81, p < 0.001; respectively). The mismatched uptake of both tracers at an acute stage was significantly related to recovery from asynergic wall motion during follow-up in group A (y = 0.45x + 13.9, r = 0.65, p < 0.005). In conclusion, despite restored myocardial perfusion by primary coronary angioplasty, BMIPP uptake is impaired in salvaged myocardium at an acute stage of infarction. However, the degree and improvement of perfusion metabolism mismatch in acute myocardial infarction may reflect subsequent recovery from postischemic wall motion abnormality in metabolically impaired but viable myocardium after coronary reperfusion.

Adult↗

PubMed1980

Thallium 201 scintigraphy.

The radioactive isotope thallium 201 behaves physiologically as a potassium analog, and when injected intravenously accumulates rapidly within the cells of many organs. Uptake of the isotope reflects both regional perfusion and sodium-potassium pump activity. The radionuclide emits 80 keV x-rays which are suitable for scintillation camera imaging. The main clinical application of (201)TI scintigraphy has been in myocardial imaging. Abnormal uptake of the isotope results in a cold spot on the myocardial image. In patients with coronary artery disease, the differentiation of ischemic and infarcted myocardium is made by comparing images obtained after injecting the radionuclide at the peak of a maximal exercise test with those obtained after injection at rest. Abnormalities due to ischemia usually are seen only on the stress image whereas fixed defects in both rest and stress studies usually indicate areas of infarction or scarring. Some investigators believe that redistribution images obtained four to six hours after stress injection (without administering further (201)TI) give the same information as a separate rest study. The sensitivity of stress imaging for detecting significant coronary disease is of the order of 80 percent to 95 percent, though computer processing of the images may be necessary to achieve the higher figure. The prediction of the extent of coronary disease from (201)TI images is less reliable. An abnormal (201)TI image is not entirely specific for coronary artery disease and the likelihood of an abnormal image being due to this diagnosis varies according to the clinical circumstances. The main clinical value of (201)TI myocardial imaging is likely to be in the noninvasive screening of patients with atypical chest pain or with ambiguous findings on stress electrocardiographic tests. It has also proved useful in studying patients with variant angina or following a coronary bypass operation. It is doubtful whether the technique is clinically helpful in most patients with suspected or established acute myocardial infarction. Imaging of organs other than the heart with (201)TI has received much less attention but has been reported in patients with peripheral vascular disease and various primary and secondary neoplasms.

Coronary Disease↗

PubMed2004

Impact of nicorandil in angina: subgroup analyses.

AIMS: IONA (impact of nicorandil in angina) is a randomised, double blind, placebo controlled trial of nicorandil, with a target dose of 20 mg twice daily. The consistency of benefits seen in subgroups is reported. METHODS: The primary composite end point of the study was coronary heart disease death, non-fatal myocardial infarction, or unplanned hospitalisation for cardiac chest pain. Subgroups were defined using baseline characteristics including, age, sex, histories of smoking, diabetes, hypertension, myocardial infarction, revascularisation, anginal status, anti-anginal treatment, other cardiovascular drugs, and an overall assessment of risk. RESULTS: A total of 5126 patients were randomised to receive nicorandil or identical placebo in addition to standard anti-anginal treatment. Overall, nicorandil reduced the incidence of the primary end point from 15.5% to 13.1% (hazard ratio (HR) 0.83, 95% confidence interval (CI) 0.72 to 0.97; p = 0.014). There was no evidence of significant heterogeneity of benefit across all subgroups studied. The absolute risk reduction was greatest and the numbers needed to treat to prevent one event was lowest in subjects at greatest risk. CONCLUSIONS: The IONA study demonstrates a significant improvement in outcome by nicorandil treatment across a broad range of patients with stable angina.

Angina Pectoris↗

PubMed1980

[Myocardial diseases: their etiology, nomenclature and classification (apropos of the classification of noncoronarogenic myocardial lesions published in Kardiologiia No. 5, 1978)].

The main forms of "noncoronarogenous" diseases of the heart muscle and the problems of their nomenclature are discussed, an attempt is made in particular to determine the borderline between the concepts of "myocardial dystrophy" and "cardiomyopathy". The article also deals with the role of infections in the origin of inflammatory processes in the heart muscle (myocarditis) and its dystrophy. A conclusion is drawn on the expediency, from the standpoint of nomenclature, to designate the pathological condition of the myocardium in the course of an infectious disease only by the term "myocarditis". The relation between "primary cardiomyopathies" and Fiedler's idiopathic myocarditis is discussed. The possible role of virus infection in the origin of the indicated forms of myocardial diseases is considered. The classification of noncoronarogenous myocardial lesions published in Kardiologia (1978, No. 5) is discussed. The author of the present article thinks that it may be appraised quite favourably on the whole, and also makes some remarks.

Cardiomyopathies↗

PubMed2006

Homocysteine lowering and cardiovascular events after acute myocardial infarction.

BACKGROUND: Homocysteine is a risk factor for cardiovascular disease. We evaluated the efficacy of homocysteine-lowering treatment with B vitamins for secondary prevention in patients who had had an acute myocardial infarction. METHODS: The trial included 3749 men and women who had had an acute myocardial infarction within seven days before randomization. Patients were randomly assigned, in a two-by-two factorial design, to receive one of the following four daily treatments: 0.8 mg of folic acid, 0.4 mg of vitamin B12, and 40 mg of vitamin B6; 0.8 mg of folic acid and 0.4 mg of vitamin B12; 40 mg of vitamin B6; or placebo. The primary end point during a median follow-up of 40 months was a composite of recurrent myocardial infarction, stroke, and sudden death attributed to coronary artery disease. RESULTS: The mean total homocysteine level was lowered by 27 percent among patients given folic acid plus vitamin B12, but such treatment had no significant effect on the primary end point (risk ratio, 1.08; 95 percent confidence interval, 0.93 to 1.25; P=0.31). Also, treatment with vitamin B6 was not associated with any significant benefit with regard to the primary end point (relative risk of the primary end point, 1.14; 95 percent confidence interval, 0.98 to 1.32; P=0.09). In the group given folic acid, vitamin B12, and vitamin B6, there was a trend toward an increased risk (relative risk, 1.22; 95 percent confidence interval, 1.00 to 1.50; P=0.05). CONCLUSIONS: Treatment with B vitamins did not lower the risk of recurrent cardiovascular disease after acute myocardial infarction. A harmful effect from combined B vitamin treatment was suggested. Such treatment should therefore not be recommended. (ClinicalTrials.gov number, NCT00266487.).

Adult↗

PubMed1996

Collagen content in normal, pressure, and pressure-volume overloaded developing human hearts.

Increased myocardial collagen accompanies pressure overload of the adult left ventricle. This phenomenon is poorly understood in infants. This study compares the myocardial volume fraction of collagen in infants who did not have primary heart disease with infants with isolated pressure overload of the right ventricle (tetralogy of Fallot [ToF]), and with infants with combined volume and pressure overload (aortic valve atresia [AVA]). The distribution of collagen in the neonatal myocardium was also determined. We measured the volume fraction of collagen from right ventricular biopsy specimens of cadaver hearts in normal infants (1 to 9 months old; n = 7), infants with ToF (1 day to 9 months old; n = 9), newborns with AVA (AVA-NB) (1 to 4 days old; n = 5), and older patients with AVA (AVA-I) (5 to 8 months old; n = 5). Myocardium from 3 patients undergoing repair of ToF (6 to 8 months old) was also analyzed. Specimens were stained with Masson's trichrome and myocardial volume fraction of collagen determined by point counting. Myocardial volume fraction of collagen was significantly higher (p = 0.02) in AVA-I patients (8.0 +/- 3.5%) versus normal (3.3 +/- 2.7%), ToF (3.2 +/- 1.8%), and AVA-NB (3.5 +/- 2.3%) patients. There was a tendency for increased collagen in the subendocardium, especially in AVA-I patients (p > 0.05). We conclude that patients with AVA-I have increased collagen relative to normal subjects, patients with ToF, and patients with AVA-NB, and that this increase is greatest in the subendocardium.

Aortic Valve↗

PubMed1997

Serum calcium: a new, independent, prospective risk factor for myocardial infarction in middle-aged men followed for 18 years.

BACKGROUND: Primary hyperparathyroidism (HPT) is a disease characterized by hypercalcemia, and associated with an increased mortality in cardiovascular diseases. However, serum calcium levels within the normal range have not been evaluated as a prospective cardiovascular risk factor. METHODS: A cohort of males aged 50 (n = 2183) were investigated in 1970-1973 for serum calcium and known cardiovascular risk factors. They were then followed up over the next 18 years. RESULTS: During the follow-up period, 180 subjects experienced a myocardial infarction (MI). The serum calcium levels were significantly elevated at the baseline (2.37 +/- 0.09 SD versus 2.35 +/- 0.09 mmol/l, p < 0.03) in the subjects who developed a MI when compared with the rest of the cohort. Also blood pressure, body mass index (BMI), fasting insulin, serum cholesterol, serum triglycerides, and the atherogenic index were significantly elevated in the MI group (p < 0.01), while HDL-cholesterol was lower at the baseline investigation (p < 0.01). Cox's proportional hazard analysis showed that only serum calcium (p < 0.01), BMI (p < 0.0003), diastolic blood pressure (p < 0.0009), and the atherogenic index (p < 0.002) were significantly independent risk factors for MI. The range of serum calcium levels from the mean value, -2 SDs to the mean value +2 SDs corresponds to a variation in estimated risk for MI ranging from 0.06 to 0.15. CONCLUSIONS: Serum calcium was found to be an independent, prospective risk factor for MI in middle-aged males suggesting a role for extracellular calcium levels in the atherosclerotic process.

Calcium↗

PubMed1998

Optimizing urography.

Urography is regarded as one of the best screening tests for evaluation of urinary tract disease and is commonly used in the search for a cause of hematuria or the presence of upper tract urothelial masses. It is also used in the evaluation of patients with trauma, known or suspected urolithiasis, or renal infection and for the documentation of obstruction or congenital abnormalities. The physician should have a basic understanding of iodinated contrast media and their benefits and effects on the patient. Patient risk factors include a history of (1) renal impairment, (2) significant allergies, (3) asthma, (4) diabetes mellitus, and (5) cardiac disease (particularly congestive heart failure, arrhythmias, unstable angina, recent myocardial infarction, and primary pulmonary hypertension). Changing options for imaging modalities, contrast media, and patient preparation require continued attention to detail and individualization to allow optimization of the urographic examination.

Humans↗

PubMed2001

Operational aspects of terminating the doxazosin arm of The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).

The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) is a randomized, practice-based trial sponsored by the National Heart, Lung, and Blood Institute (NHLBI). The double-blind, active-controlled component of ALLHAT was designed to determine whether the rate of the primary outcome-a composite of fatal coronary heart disease and nonfatal myocardial infarction-differs between diuretic (chlorthalidone) treatment and each of three other classes of antihypertensive drugs: a calcium antagonist (amlodipine), an angiotensin-converting enzyme inhibitor (lisinopril), and an alpha-adrenergic blocker (doxazosin) in high-risk hypertensive persons ages 55 years and older. In addition, 10,377 ALLHAT participants with mild to moderate hypercholesterolemia were also enrolled in a randomized, open-label trial designed to determine whether lowering serum LDL cholesterol with an HMG CoA reductase inhibitor (pravastatin) will reduce all-cause mortality as compared to a control group receiving "usual care." In January 2000, an independent data review committee recommended discontinuing the doxazosin treatment arm. The NHLBI director promptly accepted the recommendation. This article discusses the steps involved in the orderly closeout of one arm of ALLHAT and the dissemination of trial results. These steps included provisional preparations; the actual decision process; establishing a timetable; forming a transition committee; preparing materials and instructions; informing 65 trial officers and coordinators, 628 active clinics and satellite locations, 313 institutional review boards, over 42,000 patients, and the general public; reporting detailed trial results; and monitoring the closeout process. Control Clin Trials 2001;22:29-41

Adverse Drug Reaction Reporting Systems↗

PubMed1995

[Preclinical resuscitation--which factors influence the long-term course? A 5-year follow-up].

OBJECTIVE: The factors that influence long-term survival after out-of-hospital resuscitations were investigated. PATIENTS AND METHODS: Between 1985 and 1989, out of a total of 8403 responded emergency calls, 505 resuscitations were undertaken out of hospital by the emergency medical service in Göppingen. All emergency calls were recorded uniformly. Of the 505 resuscitations, 154 were primarily successful (30.5%), and 58 were secondarily successful, i.e. the patients were ultimately discharged from hospital. In 56 of them the further course could be followed at least 5 years after the resuscitation (45 males, 11 females; mean age 57 [10-83] years). The patients' charts were analysed; in 51 cases data could be obtained from the family doctor, from ambulant care or from home visits. RESULTS: 34 patients (60.4%) were still alive 5 years after the resuscitation. The highest death rate (16%) was in the first post-resuscitation year. Prognostically unfavourable factors were: advanced age (P < 0.01), underlying cardiac disease (n = 49; P < 0.025), especially coronary heart disease (n = 34; P < 0.01). Patients with primary ventricular fibrillation and previous myocardial infarction (n = 10) had a poorer prognosis than those with acute infarction (n = 24; P < 0.05). Reduced survival chances occurred in those with impaired left ventricular function, as measured echocardiographically (P < 0.05), or with cardiac arrhythmias, Lown classes III and IV (P < 0.05), as well as in those with severe neurological sequelae (n = 8; P < 0.08). CONCLUSION: Long-term prognosis depends, in the first instance, on the resuscitated patient's basic condition and not so much on the circumstances of the resuscitation.

Adolescent↗

PubMed2005

The collaborative atorvastatin diabetes study: preliminary results.

The Collaborative AtoRvastatin Diabetes Study (CARDS) is the first large primary prevention study to focus specifically on the role of a statin in patients aged 40-75 years with type 2 diabetes, but no signs or symptoms of pre-existing vascular disease and who had only average or below average cholesterol levels. The trial was a prospective double-blind randomised trial with 2383 type 2 diabetic subjects randomised to either 10-mg atorvastatin daily or placebo. Originally designed to run for 5 years, the trial was terminated over a year early in June 2003 on account of a clear benefit demonstrated for the intervention group. Over half of patients had a low-density lipoprotein cholesterol (LDL-C) below 3.3 mmol/l at entry and a quarter had an LDL-C <2.6 mmol/l. Atorvastatin 10 mg reduced LDL-C by 40% (1.2 mmol/l) on average. Results at 4 years showed a 37% relative risk reduction (p <0.001) for atorvastatin 10 mg in the primary endpoint (acute coronary heart disease death, fatal or non-fatal myocardial infarction, unstable angina requiring hospital admission, resuscitated cardiac arrest, coronary revascularisation procedures and stroke). Among the secondary endpoints, total mortality was reduced by 27% (p=0.05), acute coronary events by 36%, coronary revascularisation by 31% and stroke by 48%. The same magnitude of benefit was observed among patients with LDL-C above or below 3 mmol/l. Results observed were against a background where 9% of placebo patients had been permitted to start statin therapy after enrolment and 15% of patients on active treatment had discontinued atorvastatin. The true benefit of the intervention is therefore probably around 25% greater than the intention to treat analysis reports.

Adult↗

PubMed2005

The role of sphingosine 1-phosphate receptors in the trafficking of hematopoietic progenitor cells.

Sphingosine 1-phosphate (S1P) is an ubiquitously present extracellular lipid mediator that is released by several cell types, particularly by activated platelets. The effects of S1P are mediated by a specific family of G protein-coupled sphingosine 1-phosphate receptors (S1P1-S1P5). We demonstrate that S1P acts on hematopoietic progenitor cells as a chemotactic factor, attracting peripheral blood CD34(+) cells in vitro. Furthermore, constant activation of S1P receptors augments CXCR4-mediated signal transduction induced by stromal cell-derived factor 1 (SDF-1). These effects are most likely mediated by the S1P1 receptor consistently expressed in both primitive and committed CD34(+) hematopoietic progenitor cells (HPCs). In vivo, sustained activation of S1P1 by a receptor agonist during the homing process resulted in increased engraftment. Given the fact that activated platelets represent a major source of extracellular S1P, SDF-1-mediated stem cell homing may occur at sites of tissue injury in addition to the bone marrow. This could explain the previously observed contribution of primary hematopoietic stem cells to tissue repair in myocardial infarction and other diseases.

Animals↗

PubMed2000

[HMG-CoA reductase inhibitors in prevention of cardiovascular diseases: new mechanisms, aspects and trials].

Use of lipid-lowering drugs in both primary and secondary prevention of cardiovascular disease (CVD) decreases significantly risk of myocardial infarction, stroke, incidence of cardiovascular events, reduces the cardiovascular mortality and morbidity as well as total mortality. HMG-CoA reductase inhibitors (statins) are most potent cholesterol-lowering drugs. Statins act by inhibition of HMG-CoA reductase activity, a rate--limiting step in synthesis of cholesterol and important metabolites of mevalonate--isoprenoids. The mechanisms by which favourable antiatherogenic actions of statins occur are complex. Statins inhibit proliferation and migration of vascular smooth muscle cells, reduce free-radicals generation and LDL modification, lower Lp(a) concentration, inhibit macrophage-derived foam cells accumulation and inhibit activation of platelets, thromboxane and PAI-1 synthesis. Use of statins in the therapy of hypercholesterolemia is presently recommended by NCEP, especially in high-risk groups (diabetes, post-CABG and PTCA, kidney and heart transplantation). Nevertheless, patients with CAD and moderately elevated LDL-C levels also benefit from the treatment with statins. Because of high costs of the therapy, statins of most favourable pharmacoeconomic profile should be used.

Cardiovascular Diseases↗

PubMed2004

[Medication of the month. Adalat Oros 60 mg].

The release of Adalat Oros 60 on the Belgian market was justified since it has been clearly demonstrated that the dosage of 60 mg significantly increases the proportion of responders to nifedipine monotherapy. This gives us the opportunity to briefly review the history of nifedipine and to describe the original and ingenious galenic controlled-release formulation known as Oros (Gastrointestinal Therapeutic System, or GITS in the anglo-saxon world). Cleary, nifedipine is a potent calcium antagonist the action of which is now smooth and devoid of the usual ups and downs observed with the regular capsules, even in their Retard form. These abrupt changes in plasma concentrations, with the subsequent variations in heart rate and blood pressure, were dangerous and bothersome. Oros allows plasma concentrations of nifedipine to plateau for at least 24 hours after oral administration. This reduces the incidence of side-effects which remain those classically attributable to calcium antagonists (i.e.: flushes, headaches); interestingly, they tend to appear early after treatment initiation which allows to easily ascribe them to the drug and to quickly assess tolerance. The INSIGHT trial compared the effects on nifedipine Oros to those of a classical diuretic combination (hydrochlorothiazide-amiloride) in 6321 hypertensives who had at least one additional risk factor for cardiovascular disease. The rate of the primary outcome (a composite of cardiovascular death, myocardial infarction, heart failure, stroke) was similar in the two treatment groups, but nifedipine was superior among the subgroup of diabetics. Substudies suggested that nifedipine slows the progression of atherosclerotic lesions (carotid and coronary arteries), preserves renal function, and prevents the development of new diabetes.

Clinical Trials as Topic↗