https://immattersacp.org/weekly/archives/2012/10/16/6.htm

Beta-blockers didn't benefit stable CAD patients

Taking beta-blockers did not reduce the risk of cardiovascular events for patients with no history or a remote history of myocardial infarction (MI), according to a recent study.


Taking beta-blockers did not reduce the risk of cardiovascular events for patients with no history or a remote history of myocardial infarction (MI), according to a recent study.

The longitudinal, observational registry study included 14,000 stable patients with prior MI, 12,000 patients with coronary artery disease (CAD) and no history of MI and 19,000 patients with only risk factors for CAD. The primary outcome was cardiovascular death, nonfatal MI or nonfatal stroke. Secondary outcomes also included atherothrombotic events or a revascularization procedure. Results were published in the Oct. 3 Journal of the American Medical Association.

After a median follow-up of 44 months, cardiovascular event rates were similar between patients who had taken beta-blockers and those who hadn't among all three subgroups of patients. Those with prior MI had a slightly lower, but not significantly reduced, overall event rate if they took beta-blockers (489 [16.93%] vs. 532 [18.60%]; P=0.14). Participants on beta-blockers who had CAD and no MI actually had higher rates of the secondary outcome (odds ratio [OR], 1.14; P =0.01) and hospitalization (OR, 1.17; P=0.01) and the risk-factor-only group also saw no benefit from the beta-blockers. Patients who had a MI less than a year earlier did have a lower event rate if they took beta-blockers, however (OR, 0.77).

Study authors concluded that in these three patient groups, the use of beta-blockers was not associated with lower risk of cardiovascular events. They noted that these findings are consistent with recent guideline changes in which beta-blocker therapy has been downgraded. They noted that the benefits of beta-blockers have been extrapolated from patients with MI and heart failure to other patients with CAD or risk for developing it, without evidence to support these conclusions.

“Further research is warranted to identify subgroups that benefit from beta blocker therapy and the optimal duration of beta blocker therapy,” the authors concluded.