Nifedipine improves coronary and peripheral endothelial function in patients with coronary artery disease: Are calcium channel blockers acquitted on the charges?

Abstract

We have read with great enthusiasm the recently published article by Takase et al. [1]. This meticulously designed study helped us to refocus on calcium channel blockers in the prevention of endothelial dysfunction and atherosclerosis. Takase et al. revealed that acute administration of nifedipine improves not only coronary but also brachial artery vasodilator responses to acetylcholine by using invasive tests in patients with coronary artery disease (CAD). They concluded that nifedipine improves coronary and peripheral endothelial function in patients with CAD. Endothelial dysfunction is thought to play a pivotal role in the development, progression and clinical complications of atherosclerosis [2]. The vascular endothelium has emerged as an attractive treatment target, given accumulating data suggesting an important role of endothelial dysfunction for prognosis in vascular disease including coronary arterial tree. Although calcium channel blockers (CCBs) were developed as vasodilators, with the evolution of second and thirdgeneration CCBs, pleitropic effects have been noticed, and at least some of CCBs' benefit is attributable to these mechanisms [3]. CCBs have been shown to enhance the effects of nitric oxide and diminish those of endothelin-1 on vascular smooth muscle cell improving endothelial function. This phenomenon might be related to the antioxidant properties of some CCBs like amlodipine and nisoldipine [4]. Effect of Nifedipine and Cerivastatin on Coronary Endothelial Function in Patients with Coronary Artery Disease (ENCORE) study showed that combination of nifedipine and cerivastatin improved endothelial function [5].