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Beta-Blockers Failed to Lower CV Events in Stable Patients
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 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).
Sripal Bangalore
The event rates for patients with CAD but without MI were 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).