Purpose

Calcium channel blockers (CCBs) do not reduce the risk of initial or recurrent myocardial infarction (MI) in patients diagnosed with stable coronary artery disease (CAD). The aim of this current study was to evaluate the association between CCBs and aspirin resistance in patients with CAD.

Methods

Patients with stable CAD who were regularly taking aspirin (75–100 mg qd) for at least 1 month prior to enrollment in the study were included. The VerifyNow system was used for platelet function testing with high on-aspirin platelet reactivity (HAPR) defined as aspirin reaction units (ARU) >550. We compared patients treated with CCBs versus control group.

Results

Five hundred three patients with CAD were included in this study, and 88 were treated with CCBs. Mean age (67.9±9.7 in the CCB group vs. 66.5±11.4 in the control group), gender (77.3 male vs. 82.9%), rates of diabetes mellitus (34.7 vs. 36.9%), rates of CKD (23.5 vs. 23.5%), dyslipidemia (85.1 vs. 85.3%), and statin therapy (89.5 vs. 90.7%) were similar. The mean ARU was 465.4±70.0 for patients treated with CCBs versus 445.2±60.0 in controls (p=0.006). Similarly, 15.9% of CCB patients demonstrated HAPR compared to 7.0% (p=0.006). The administration of CCBs was independently associated with HAPR in a multivariate analysis (OR 1.72, 95% CI: 1.04–8.91, p=0.047) as well as in propensity score matched analysis (OR 1.56; CI: 1.22–1.93; p<0.001).

Conclusions

Usage of CCBs is positively correlated with aspirin resistance. These findings may suggest an adverse pharmacologic effect of CCBs among patients with stable CAD treated with aspirin.

中文翻译：

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钙通道阻滞剂对冠状动脉疾病患者阿司匹林反应性的影响

目的

钙通道阻滞剂 (CCB) 不能降低确诊为稳定型冠状动脉疾病 (CAD) 患者的初始或复发性心肌梗死 (MI) 的风险。本研究的目的是评估 CAD 患者 CCB 与阿司匹林抵抗之间的关联。

方法

纳入研究前至少 1 个月定期服用阿司匹林（75-100 mg qd）的稳定型 CAD 患者被纳入研究。VerifyNow 系统用于血小板功能测试，阿司匹林血小板反应性高 (HAPR) 定义为阿司匹林反应单位 (ARU) >550。我们比较了接受 CCB 治疗的患者与对照组。

结果

这项研究包括 503 名 CAD 患者，其中 88 名接受了 CCB 治疗。平均年龄（CCB 组 67.9±9.7 对对照组 66.5±11.4）、性别（77.3 男性对 82.9%）、糖尿病发病率（34.7 对 36.9%）、CKD 发病率（23.5 对23.5%）、血脂异常（85.1 对 85.3%）和他汀类药物治疗（89.5 对 90.7%）相似。接受 CCB 治疗的患者的平均 ARU 为 465.4±70.0，而对照组为 445.2±60.0（p = 0.006）。同样，15.9% 的 CCB 患者表现出 HAPR，而这一比例为 7.0% ( p = 0.006)。在多变量分析（OR 1.72，95% CI：1.04-8.91，p = 0.047）以及倾向评分匹配分析（OR 1.56；CI：1.22-1.93；p<0.001)。

结论

CCBs的使用与阿司匹林耐药呈正相关。这些发现可能表明 CCB 在接受阿司匹林治疗的稳定型 CAD 患者中的不良药理作用。