The Efficacy of Beta Blockers in Patients with and without MI

Can beta blockers lower cardiovascular events…

There are more signs that beta blockers are potentially harmful to some patients with coronary artery disease or with coronary artery disease risk factors.

A new study included 4772 patients with prior MI, 7804 patients with atherothrombosis, and 2101 patients with risk factors alone without heart failure. The primary outcome was a combination of nonfatal MI, stroke, or cardiovascular mortality. The cohorts were then divided into 2 groups based on baseline B-blocker use.

After 28 months of follow-up, beta-blocker use was associated with a 31% lower risk of primary outcome (7.1% versus 10.2%) and lower risk of recurrent MI (3.4% versus 4.9%) with no difference in mortality (5.3% versus 6.7%). B-blocker use was not associated with lower ischemic outcome in atherothrombotic but a higher risk of stroke (3.5% vs. 1.5%) compared to those not taking beta-blockers.

In summary, beta-blocker use in patients with prior MI was associated with a lower composite cardiovascular outcome. However, beta-blocker use was not associated with lower cardiovascular event in patients without MI. Plus, the results support previous speculations of the potential increased risk of stroke with beta-blocker. The adverse effects of beta-blockers should also be taking into consideration; including weight gain, masking the symptoms of diabetes, worsening cholesterol control, sexual dysfunction and fatigue. The author noted one of the limitations of the study was that older beta-blockers were used at the time of the study.

Practice Pearls

• Beta-blockers can be beneficial not only in post MI but also in heart failure with atrial fibrillation and for stable angina.
• The use of beta-blockers could possibly increase the risk of stroke.
• Beta-blockers do not work like the way they used to, we have to look at patient specific.

Bangalore S, Bhatt DL, Steg PG, et al. ß-blockers and cardiovascular events in patients with and without myocardial infarction: Post hoc analysis from the CHARISMA trial. Circ Cardiovasc Qual Outcomes 2014; DOI:10.1161/CIRCOUTCOMES.114.001073. Abstract