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CHARISMA: Beta-blockers lowered CV events in patients with MI
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Beta-blocker use was associated with a lower rate of CV events for individuals without HF who had a prior MI, but not for those without a prior MI, according to data from the CHARISMA trial.
Additionally, researchers observed a trend toward elevated risk for stroke in individuals without MI who used beta-blockers compared with individuals who did not use beta-blockers.
Sripal Bangalore, MD, MHA, associate professor of medicine, director of research at the Cardiac Catheterization Laboratory and director of the Cardiovascular Outcomes Group at the Cardiovascular Clinical Research Center at New York University School of Medicine, and colleagues conducted a post-hoc analysis of participants without HF from the CHARISMA trial. This included 4,772 participants with prior MI, 7,804 with known atherothrombosis and 2,101 with risk factors for CVD.
Sripal Bangalore
Participants were stratified within their cohort based on beta-blocker use at baseline. The primary outcome was a composite of nonfatal MI, stroke and CV mortality. Mean follow-up was 28 months. The researchers used propensity score analysis within each of the three cohorts to better control for confounding and bias.
In the propensity-matched cohort of participants with prior MI, beta-blocker use was associated with lower risk for the primary outcome compared with nonuse (7.1% vs. 10.2%; HR=0.69; 95% CI, 0.5-0.94). This result was primarily driven by a lower rate of recurrent MI (3.4% vs. 4.9%; HR=0.62; 95% CI, 0.39-1), and there was no difference in mortality (users, 5.3%; nonusers, 6.7%; P=.2), according to the results.
Beta-blocker use was not associated with a lower rate of CV events in the cohorts of participants with known atherothrombosis and with CV risk factors alone, Bangalore and colleagues found. However, they determined that in the risk-factor-alone cohort, there was a trend toward higher risk for stroke associated with beta-blocker use (users, 3.5%; nonusers, 1.5%; HR=2.13; 95% CI, 0.92-4.92), and that the risk became significant in the regression model adjusted to the propensity score (HR=2.69; 95% CI, 1.33-5.44).
“In patients without previous events but with multiple [CV] risk factors, there is concern that these agents might increase the risk of stroke,” Bangalore and colleagues wrote. “Randomized controlled trials are needed to evaluate the efficacy of newer beta-blockers with vasodilating properties in patients without [HF] or [left ventricular] systolic dysfunction.”
Disclosure: The CHARISMA trial was funded by Sanofi Aventis and Bristol-Myers Squibb. See the full study for a list of the researchers’ relevant financial disclosures.
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