{"id":32122,"date":"2012-10-02T16:00:16","date_gmt":"2012-10-02T20:00:16","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=news&#038;p=32122"},"modified":"2012-10-03T10:40:05","modified_gmt":"2012-10-03T14:40:05","slug":"registry-study-raises-questions-about-cardioprotective-effect-of-beta-blockers","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2012\/10\/02\/registry-study-raises-questions-about-cardioprotective-effect-of-beta-blockers\/","title":{"rendered":"Registry Study Raises Questions About Cardioprotective Effect of Beta-Blockers"},"content":{"rendered":"<p>Although beta-blockers have been a cornerstone of therapy for patients with coronary artery disease for more than a generation, a <a href=\"http:\/\/jama.jamanetwork.com\/article.aspx?articleid=1367524\">new study in <em>JAMA<\/em><\/a> suggests that that in the modern era, beta-blockers might not improve outcomes.<\/p>\n<p>Sriapl Bangalore and colleagues analyzed data from 44,708 patients enrolled in the Reduction of Atherothrombosis for Continued Health (REACH registry), of whom 31% had a prior MI, 27% had documented CAD without MI, and 42% had CAD risk factors only. Patients who received beta-blockers were compared with matched controls and were followed for a median of 44 months.<\/p>\n<p>Beta-blocker use was not associated with a significant reduction in the rate of cardiovascular death, nonfatal MI, or nonfatal stroke. Here are the rates:<\/p>\n<p>Among CAD patients with prior MI:<\/p>\n<ul>\n<li>16.93% in the beta-blocker group versus 18.60% in the controls, hazard ratio [HR] 0.90, CI 0.79-1.03, p=0.14<\/li>\n<\/ul>\n<p>CAD patients without prior MI:<\/p>\n<ul>\n<li>12.94% versus 13.55%, HR 0.92, CI 0.79-1.08, p=0.31<\/li>\n<\/ul>\n<p>Patients with risk factors only:<\/p>\n<ul>\n<li>14.22% versus 12.11%, HR 1.18, CI 1.02-1.36, p=0.02<\/li>\n<\/ul>\n<p>In their paper, the REACH investigators point out that the evidence supporting beta-blocker use after MI is now quite old, with most of the trials having been performed prior to the widespread use of modern reperfusion strategies and medical therapy. The presumed &#8220;cardioprotective&#8221; effect of beta-blockers in patients without MI did not have an evidence base and was an extrapolation from heart failure trials and older post-MI trials. On the other hand, they note, there is evidence\u00a0to\u00a0support the use of beta-blockers in acute MI patients without shock or heart block.<\/p>\n<p>Although the finding may be surprising to some clinicians, the results are consistent with recent guidelines, the authors note. In\u00a0<a href=\"http:\/\/circ.ahajournals.org\/content\/124\/22\/2458\">the AHA secondary prevention guidelines,<\/a> beta-blockers receive a class I recommendation for heart failure, MI, or ACS for up to 3 years after MI but only a IIa recommendation for longer-term therapy. For other patients, beta blockers receive a class IIb recommendation.<\/p>\n<p><em>For a CardioExchange Q&amp;A with the study&#8217;s author &#8211; and to share your own comments about the study &#8211; see <a href=\"http:\/\/blogs.nejm.org\/cardioexchange\/expert-is-in\/long-term-use-of-beta-blockers-questioned-in-certain-patients\/\">here<\/a>.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Although beta-blockers have been a cornerstone of therapy for patients with coronary artery disease for more than a generation, a new study in JAMA suggests that that in the modern era, beta-blockers might not improve outcomes. Sriapl Bangalore and colleagues analyzed data from 44,708 patients enrolled in the Reduction of Atherothrombosis for Continued Health (REACH [&hellip;]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,7],"tags":[312,1487,1488],"class_list":["post-32122","post","type-post","status-publish","format-standard","hentry","category-general","category-prevention","tag-beta-blockers","tag-cardioprotection","tag-cardiovascular-events"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/32122","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=32122"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/32122\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=32122"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=32122"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=32122"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}