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Beta-blockers failed to lower CV events in stable patients
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In an observational study, use of beta-blockers did not lead to a lower risk of composite CV events in patients with CAD risk factors only, known prior MI or known CAD without MI.
To assess this association, Sripal Bangalore, MD, MHA, and fellow investigators conducted a longitudinal, observational study of patients in the Reduction of Atherothrombosis for Continued Health (REACH) registry. Patients were divided into three cohorts: known prior MI (n=14,043), known CAD without MI (n=12,012) or those with CAD risk factors only (n=18,653). They defined the primary outcome as a composite of CV death, nonfatal MI or nonfatal stroke, and the secondary outcome as the primary outcome plus hospitalization for atherothrombotic events or a revascularization procedure.
In the prior MI group, the event rates were not significantly different among those with beta-blocker use vs. those without beta-blocker use for the primary outcome (HR=0.90; 95% CI 0.79-1.03), secondary outcome or any of the tertiary outcomes (CV death, MI or stroke).
The event rates for patients with CAD but without MI were also not significantly different in those with beta-blocker use for the primary outcome vs. without beta-blocker use (12.94% vs. 13.55%; HR=0.92; P=.31), with higher rates for the secondary outcome (30.59% vs. 27.84%; OR=1.14; P=.01) and the tertiary outcome of hospitalization (24.17% vs. 21.48%; OR=1.17; P=.01).
Among patients with CAD risk factors only, event rates were higher for the primary outcome with beta-blocker use vs. without beta-blocker use (14.22% vs. 12.11%; HR=1.18; P=.02) and for the secondary outcome (22.01% vs. 20.17%; OR=1.12; P=.04), but not for the tertiary outcomes of MI (2.82% vs. 2%; HR=1.36; P=.08) and stroke (6.55% vs. 5.12%; HR=1.22; P=.06).
However, beta-blocker use was associated with a lower incidence of the secondary outcome in those with recent MI in the previous year (OR=0.77; 95% CI, 0.64-0.92).
Sripal Bangalore
“Our observation that beta-blocker use was not associated with a lower rate of CV events among patients with MI and among those with CAD but no history of MI is consistent with the recently updated American Heart Association secondary prevention guidelines in which beta-blocker therapy is a class I recommendation only for HF, MI or ACS for up to 3 years after MI, but is a class IIa recommendation for longer-term therapy,” Bangalore and colleagues wrote.
Disclosure: Bangalore reports no relevant financial disclosures.
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