Heart Problems Not Blocked by Beta-Blockers

Beta blockers may not prevent heart events in coronary artery disease patients

(RxWiki News) Beta-blockers used to lower blood pressure are regularly prescribed for patients with coronary artery disease. However, new research suggests the medication may not lower the risk of recurrent heart events.

Beta-blockers were not found to lower the total risk of heart events, including cardiovascular-related mortality or non-fatal heart attack or stroke, among patients with coronary artery disease or those who previously had a heart attack.

"Discuss the benefits of beta-blockers with your cardiologist."

Sripal Bangalore, MD, MHA, a lead researcher from the New York University School of Medicine, noted in the study that beta-blockers remain the standard of care for coronary artery disease patients, particularly those that have had a heart attack.

Evidence suggesting beta-blockers could offer a benefit to coronary artery disease patients was primarily suggested by old clinical trials and heart failure studies. Investigators initiated the study to determine the impact of beta-blockers on long-term cardiovascular outcomes.

During the observational study researchers reviewed data from 44,708 patients participating in the Reduction of Atherothrombosis for Continued Health (REACH) registry. Of those patients, 14,043 had previously experienced a heart heart attack, 12,012 had documented coronary artery disease and 18,653 had risk factors for coronary artery disease. Patients were followed an average of 44 months with the final data collection occurring in April 2009.

Among heart attack patients, there was no significant difference in the number of heart events regardless of whether individuals took beta-blockers. About 17 percent who took beta-blockers had another cardiovascular event compared to 19 percent who did not take the medication.

In patients with coronary artery disease or risk factors for coronary artery disease, patients who took beta-blockers were slightly more likely to experience a cardiovascular event such as a heart attack or stroke.

In those with coronary artery disease, 13 percent who took beta-blockers had a heart event compared to 14 percent in those who didn't take the drug. Patients who took beta-blockers were also more likely to be hospitalized following a heart event.

Among individuals with risk factors for coronary artery disease, 14 percent of beta-blocker users and 12 percent of those not taking beta-blockers experienced cardiovascular events.

Investigators also found that patients who had experienced a heart attack within the last year were less likely to experience a cardiovascular event leading to a blood clot that required hospitalization or revacularization if they took beta-blockers.

Sarah Samaan, MD, a cardiologist with Legacy Heart Center and co-director of the Women’s Cardiovascular Institute at the Baylor Heart Hospital, noted that for years it has been taken as gospel that all patients with coronary heart disease should take beta-blockers unless there is a good reason to skip them.

In fact, she said that hospital and insurance groups often track the use of beta-blockers in heart patients and send reminders that doctors are not meeting practice guidelines if patients are not prescribed the drugs. Doctors also may be asked to justify why patients are not taking them.

"While beta-blockers can be life saving in people with heart attacks, heart rhythm abnormalities or congestive heart failure, this study shows us that for the average patient with stable heart disease or risk factors for heart disease, beta-blockers are not mandatory and, in the case of those with risk factors but no heart history, may even cause harm," said Dr. Samaan, also author of "Best Practices for a Healthy Heart: How to Stop Heart Disease Before or After It Starts."

"There are a number of different beta-blockers, and some may be more beneficial than others. The study did not address this specific question. And for some with high blood pressure, beta-blockers are the only medication that can control the problem effectively."

Dr. Samaan emphasized that patients should not stop taking beta-blockers without first talking to their cardiologist or primary care doctor as there are good reasons to continue taking the medication in specific individuals. However, she said it is reasonable for patients to question whether alternative drugs may be more appropriate, especially if they are noticing side effects such as fatigue, depression or low libido.

Additional research will be needed to determine which patients benefit from beta-blocker therapy and the optimal amount of time the medication should be taken.

The study was published in the Oct. 3 edition of the Journal of the American Medical Association.

Review Date: 
October 1, 2012