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Beta-blocker benefit questioned in patients taking RAAS inhibitors, statins
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Patients who adhered to ACE inhibitors or angiotensin II receptor antagonists in addition to statins had similar mortality rates as patients who adhered to those two therapies and beta-blockers, according to a study published in the Journal of the American College of Cardiology.
Maarit J. Korhonen, LicSci(Pharm), PhD , senior research fellow at Monash University Faculty of Pharmacy and Pharmaceutical Sciences in Australia, and colleagues analyzed data from 90,869 patients (45% men) who were Medicare beneficiaries, aged at least 65 years, had an index acute MI hospitalization between 2008 and 2010 and survived at least 180 days after the hospitalization.
Patients were also given three therapies within 30 days of discharge: Renin-angiotensin-aldosterone system inhibitors (ACE inhibitors or angiotensin receptor antagonists), statins and beta-blockers. Researchers measured adherence to the therapies for 180 days after hospital discharge.
Those who adhered to ACE inhibitors/angiotensin receptor antagonists and statins had a similar mortality rate to patients who adhered to all three therapies (adjusted HR = 0.98; 95% CI, 0.91-1.07).
The highest mortality rate was seen in patients who were nonadherent to all three therapies (adjusted HR = 1.65; 95% CI, 1.54-1.76).
The following were adjusted HRs for different types of adherence:
- 1.32 for beta-blockers only (95% CI, 1.21-1.44);
- 1.26 for statins only (95% CI, 1.15-1.38);
- 1.19 for ACE inhibitors or angiotensin receptor antagonists only (95% CI, 1.07-1.32);
- 1.17 for statins and beta-blockers only (95% CI, 1.1-1.25); and
- 1.12 for ACE inhibitors/angiotensin receptor antagonists and beta-blockers only (95% CI, 1.04-1.21).
“Our findings suggest that long-term adherence to ACE inhibitors/[angiotensin receptor antagonists] and statins may be more important than adherence to beta-blockers after [acute] MI,” Korhonen and colleagues wrote.
“The final sticky issue raised by Korhonen et al centers on what can be done to reduce medication nonadherence,” Eric D. Peterson, MD, MPH, professor of medicine at Duke University School of Medicine and director of Duke Clinical Research Institute, and Ann Marie Navar, MD, PhD, assistant professor of medicine at Duke University School of Medicine, member in the Duke Clinical Research Institute and Cardiology Today Next Gen Innovator, wrote in a related editorial. “A number of potentially useful tools to improve patient adherence have been proposed, including: patient education, behavioral counseling, electronic and mobile reminders, financial and nonfinancial incentives and even family and peer engagement. ... Even modest improvements in adherence rates can result in clinically significant improvements in patient outcomes.” – by Darlene Dobkowski
Disclosures: Korhonen reports no relevant financial disclosures. Peterson reports he received research funding from AstraZeneca, Eli Lilly, Genentech, Janssen Pharma, Merck and Co., Regeneron Pharm and Sanofi; and consulting support from Bayer, Daiichi-Sankyo, Janssen, Merck and Co., Regeneron and Sanofi. Navar reports she consulted for Amgen, Regeneron and Sanofi; and received research consulting fees from Amgen and Sanofi. Please see the study for all other authors’ relevant financial disclosures.
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