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Several CCBs, including nifedipine, have been shown to be effective in slowing the development of atherosclerotic plaques in animals fed a high-cholesterol diet (Henry P et al. J Clin Invest 1981). Subsequently, trials have been conducted to ascertain whether these effects can be replicated in humans. In the International Nifedipine Trial on Antiatherosclerotic Therapy (INTACT), patients with mild coronary artery disease (CAD) received nifedipine or placebo. In the nifedipine group, there were 28% fewer new lesions per patient than the placebo group (p=0.034), but there was no effect on pre-existing lesions compared with placebo (Lichtlen P et al. Lancet 1990). The effect of combining CCBs with lipid-lowering therapy (pravastatin) on the progression of established atherosclerotic lesions was determined in an analysis of data from the Regression Growth Evaluation Statin Study (REGRESS). Cotreatment with CCBs and pravastatin produced, on average, 0.05mm less lesion progression compared with no CCB cotreatment (p=0.0016) (Jukema J et al. Arterioscler Thromb Vasc Biol 1996). Furthermore, cotreatment with CCBs produced 50% fewer new lesions per patient (p=0.0026). In both cases there was no significant effect of CCB monotherapy. In the Prospective Randomised Evaluation of the Vascular Effects of Norvasc Trial (PREVENT), therapy with the CCB amlodipine reduced IMT by 0.0126mm, compared with a 0.033mm increase in the placebo group (p=0.007; Pitt B et al. Circulation 2000). The effects of nifedipine on preventing lesion progression in CAD patients with hypertension were compared with the effects of ACE inhibitors in the Japan Multicenter Investigation for Cardiovascular Diseases (J-MIC) trial. The results showed that nifedipine was significantly more effective than ACE inhibitors in preventing lesion progression (64% versus 38%; p=0.009). Jukema JW, Zwinderman AH, van Boven AJ, et al. Evidence for a synergistic effect of calcium channel blockers with lipid-lowering therapy