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From the Channing Laboratory (K.B.M., B.A.R., J.E.M., M.J.S., W.C.W.) and
Division of Preventive Medicine (J.E.M., C.H.H.), Department of Medicine,
Harvard Medical School and Brigham and Women's Hospital; and Department
of Epidemiology (K.B.M., J.E.M., M.J.S., A.M.W., W.C.W., C.H.H.),
Biostatistics (B.A.R.), and Nutrition (M.J.S., W.C.W.), Harvard School of
Public Health, Boston, Mass.
Correspondence to Dr Karin Michels, Channing Laboratory, 181 Longwood Ave, Boston, MA 02115. E-mail karin.michels{at}channing.harvard.edu
Background—In several observational studies, patients
prescribed calcium channel blockers had higher risks of
cardiovascular diseases and mortality than those
prescribed other antihypertensive medications. We explored these
associations in the Nurses' Health Study.
Methods and Results—A total of 14 617 women who reported
hypertension and regular use of diuretics, ß-blockers,
calcium channel blockers, ACE inhibitors, or a combination
in 1988 were included in the analyses.
Cardiovascular events and deaths were ascertained
through May 1, 1994. We documented 234 cases of myocardial infarction.
Calcium channel blocker monodrug users had an age-adjusted relative
risk (RR) of myocardial infarction of 2.36 (95% CI, 1.43 to 3.91)
compared with those prescribed thiazide diuretics. Women
prescribed calcium channel blockers had a higher prevalence of
ischemic heart disease. After adjustment for these and other
coronary risk factors, the RR was 1.64 (95% CI, 0.97 to 2.77).
Comparing the use of any calcium channel blocker (monodrug and
multidrug users) with that of any other antihypertensive agent, the
adjusted RR was 1.42 (95% CI, 1.01 to 2.01). An association between
calcium channel blocker use and myocardial infarction was apparent
among women who had ever smoked cigarettes (covariate-adjusted RR,
1.81; 95% CI, 1.20 to 2.72) but not among never-smokers (RR, 0.94;
95% CI, 0.48 to 1.84).
Conclusions—In analyses adjusted only for age, we found a
significant elevation in RR of total myocardial infarction among women
who used calcium channel blockers compared with those who did not.
After adjustment for comorbidity and other covariates, the RR was
reduced. Whether the remaining observed elevated risk is real, or a
result of residual confounding by indication, or chance, or a
combination of the above cannot be evaluated with certainty on the
basis of these observational data.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Prospective Study of Calcium Channel Blocker Use, Cardiovascular Disease, and Total Mortality Among Hypertensive Women
The Nurses' Health Study
Key Words: calcium channels • cardiovascular diseases • mortality • epidemiology
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