B-Vitamin Protective Against Mortality Risk in Angina Patients Treated with Calcium Channel Blockers

by | Jun 20, 2024 | 2023, Cardiovascular Health, Recent Articles, Vitamin B - General, Vitamins

Written by Chrystal Moulton, Science Writer. In patients not treated with B vitamins, after adjusting for all covariates, researchers found a significant risk in all-cause mortality [model 3: HR-1.54, P < 0.041] and CVD mortality [model 3: HR-1.69, P < 0.041].

cardiovascular healthPatients with stable angina pectoris are generally treated with calcium channel blockers1. However, conflicting research demonstrates beneficial prognosis, no benefit on survival, and other research linked to higher mortality risk2-5. Furthermore, treatment with calcium channel blockers is linked to high levels of homocysteine, which is associated with worsening prognosis in patients with cardiovascular disease6,7.  B-vitamins have been associated with reduced levels of homocysteine however, CVD risk was not reduced as a result8,9. In the current study, researchers investigated the mortality risk in patients treated with calcium channel blockers with and without vitamin B supplementation5.

The study was designed as a large prospective cohort study. Patients undergoing coronary angiography between 2000 and 2004 were included in this investigation. A subset of these patients was enrolled in an ongoing trial called the Western Norway B vitamin Intervention Trial (WENBIT). Patients in that trial received daily folic and B 12 vitamin treatment at various doses or placebo. Patients were excluded if covariate data was missing, no data was provided on calcium channel blocker usage, and if left ventricular ejection fraction was <40%. Baseline data regarding hypertension, smoking, coronary artery disease at angiography, diabetes status, and left ventricular ejection fraction was collected from all participants included. Blood samples were collected immediately before or after coronary angiography. Patients were followed up from enrollment until death or the end of 2012 with a primary focus on cardiovascular, all cause, and non-cardiovascular mortality. Linear regression and Pearson chi square-test were conducted to determine statistical significance. Data was assessed against three models:

  • Model 1- gender, age, and cohort control variable
  • Model 2- gender, age, cohort- control variable diabetes, extent of coronary artery disease, smoking, hypertension, heart failure, estimated glomerular filtration rate, previous percutaneous coronary intervention, myocardial infarction heart failure, an atrial fibrillation.
  • Model 3- model 2 plus beta blockers, statins, angiotensin converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARB)

Out of 4166 patients undergoing coronary angiography, 3991 were eligible for this analysis. Median age of patients in this analysis was 62 years old and 22.7% of them were prescribed calcium channel blockers (CCB) at baseline. Researchers found that patients treated with calcium channel blockers (CCB) had significantly higher plasma homocysteine, fibrinogen, and erythrocyte sedimentation rate (P < 0.01) They were also more likely prescribed medications after angiography such as beta blockers, statins, aspirin, ACE inhibitors and ARBs (P < 0.01). They also had significant coronary heart disease reflected in prior percutaneous coronary intervention data [PCI] (P < 0.001). Median follow up was 10.3 years. A total of 822 participants died: 356 from cardiovascular disease and 466 not related to cardiovascular issues. Statistical analysis showed that patients treated with CCB had a significantly lower survival rate in all-cause mortality [model 3: HR-1.34, P < 0.001], cardiovascular death [model 3: HR-1.35, P < 0.01], non-cardiovascular death [model 3: HR-1.33, P < 0.01] after adjusting for all covariates. In patients not treated with B vitamins, after adjusting for all covariates, researchers found a significant risk in all-cause mortality [model 3: HR-1.54, P < 0.041] and CVD mortality [model 3: HR-1.69, P < 0.041]. No statistical significance was seen in non-CVD deaths among patients using CCB with or without B-vitamin treatment. In patients with at least one stenosis coronary artery, 695 died while 127 deaths occurred in patients with no stenosis. Researchers observed as significant risk in all-cause mortality [HR- 1.71 versus HR- 1.21, P = 0.022] and CVD death in patients [HR- 1.92 versus HR- 1.14, P = 0.02] not treated with B vitamins versus those treated with B vitamins. Overall, the data showed significantly increased risk of all-cause and CVD mortality among patients treated with calcium channel blockers without B vitamins supplementation.

Data from this research demonstrated B vitamins supplementation having a protective effect in all-cause and CVD related mortality in patients with stable angina pectoris prescribed calcium channel blockers. Additional research will be needed to verify the results of this analysis.

Source: Dhar, Indu, Gard FT Svingen, Espen Ø. Bjørnestad, Arve Ulvik, Sahrai Saeed, and Ottar K. Nygård. “B-vitamin Treatment Modifies the Mortality Risk Associated with Calcium Channel Blockers in Patients with Suspected Stable Angina Pectoris: A Prospective Cohort Study.” The American Journal of Clinical Nutrition 118, no. 1 (2023): 77-84.

© 2023 The Authors. Published by Elsevier Inc. on behalf of American Society for Nutrition. This is an open access article under the CC BY-NC-ND license (http://
creativecommons.org/licenses/by-nc-nd/4.0/).

Click here to read the full text study.

Posted June 20, 2024.

Chrystal Moulton BA, PMP, is a 2008 graduate of the University of Illinois at Chicago. She graduated with a bachelor’s in psychology with a focus on premedical studies and is a licensed project manager. She currently resides in Indianapolis, IN.

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