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Beta-blockers most effective in patients with recent MI
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For patients with new-onset CHD, use of beta-blockers was associated with lower risk for cardiac events only in patients with a recent MI.
Previous research demonstrated that beta-blockers are effective at reducing risk for CV events and mortality in patients with a recent MI or HF with systolic dysfunction; however, there was a lack of a large trial to assess the effectiveness of beta-blockers in patients with incident CHD and no history of recent MI, according to the study background.
Researchers studied electronic health records from Kaiser Permanente Northern California between 2000 and 2008 to identify patients discharged after a first CHD event (ACS or coronary revascularization) and did not use beta-blockers in the year before admission (n=26,793).
Of those patients, 19,843 initiated beta-blocker treatment within 7 days of discharge from the initial CHD event. The researchers determined the HR associated with beta-blocker treatment and analyzed whether it differed for patients with and without a recent MI.
Mean follow-up was 3.7 years. There were two endpoints: all-cause mortality and a composite of all-cause mortality and hospitalization for acute MI.
Hazard reduced
Charlotte Andersson, MD, PhD, from the department of cardiology at Gentofte University Hospital, Hellerup, Denmark, and colleagues found that 6,968 patients had an MI or died during the study period.
Overall, use of beta-blockers was associated with a reduced hazard for mortality (adjusted HR=0.9; 95% CI, 0.84-0.96) and for mortality or MI (adjusted HR=0.92; 95% CI, 0.87-0.97), according to the researchers.
However, patients with a recent MI benefited from beta-blocker treatment in terms of reducing risk for death (recent MI, HR=0.85; no recent MI, HR=1.02; P=.007) or death or MI (recent MI, HR=0.87; no recent MI, HR=1.03; P=.005). The same trend was not observed for patients without evidence of a recent MI.
“These results, as well as those of prior studies, suggest that beta-blockers may not reduce adverse cardiac events in patients who do not have a history of MI,” the researchers wrote. They also noted that a randomized clinical trial to test whether beta-blockers reduce risk for hard endpoints among patients with CHD, but not MI, is warranted.
Not mandated
P. Gabriel Steg
In a related editorial, P. Gabriel Steg, MD, director of the coronary care unit at Hôpital Bichat – Claude Bernard, Paris, and member of the Cardiology Today’s Intervention Editorial Board, and Ranil De Silva, PhD, from the National Heart and Lung Institute, Imperial College London, said this study “strengthens the view that systematic use of beta-blockers is not mandated on prognostic grounds for all patients with stable CAD, especially in the absence of previous MI. These drugs should be used for symptomatic angina relief.”
The editorialists noted, however, that “the results may be in part attributable to insufficient power to detect a benefit of beta-blockade in stable CAD patients without previous MI, and of uncertain relevance to the broader population of stable CAD patients not captured in the current analysis.”
For more information:
Andersson C. J Am Coll Cardiol. 2014;64:247-252.
Steg PG. J Am Coll Cardiol. 2014;64:253-255.
Disclosure: The study was funded by the American Heart Association and the Danish Agency for Science, Technology and Innovation. The researchers and De Silva report no relevant financial disclosures. Steg reports financial ties with Amarin, AstraZeneca, Aterovax, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Eli Lilly, GlaxoSmithKline, Janssen Pharmaceuticals, The Medicines Company, Medtronic, Merck Sharpe & Dohme, Novartis, Otsuka, Pfizer, Roche, Sanofi, Servier and Vivus.