2023-07-11 11:30:38
WASHINGTON, July 10, 2023 (APMnews) – Beta-blocker treatment of patients with stable coronary disease has a moderate preventive effect on the risk of myocardial infarction, suggests a Canadian observational study published in the Journal of the American College of Cardiology (JACC).
β-blockers are widely used in coronary disease. But if, in patients with a history of infarction, this prescription is justified by studies (which however are old) showing an effect in this use in secondary prevention, in stable coronary disease on the other hand, apart from an effect on angina, there was no conclusive data on a possible effect on major cardiovascular events, recall Lucas Godoy of the University of Toronto and his colleagues. But despite this lack of evidence, more than 70% of stable coronary patients are prescribed a β-blocker.
They wanted to clarify this question, the answer to which has remained unclear for many years, by studying all patients over the age of 65 who had a diagnostic coronary angiogram in Ontario between 2009 and 2019 and were confirmed to have obstructive coronary artery disease. They compared those (45.3%) who were prescribed a β-blocker and those who weren’t.
The primary endpoint of the study included death and hospitalization for infarction or heart failure. This criterion was reduced by 8% by β-blockers, which was modest but statistically significant.
A separate analysis of each type of event shows that hospitalizations for myocardial infarction were reduced by 13%.
This corresponded, in the population studied, to a five-year risk of infarction of 3.4% with treatment with a β-blocker and 4% without a β-blocker.
On the other hand, deaths from all causes and cardiovascular deaths as well as hospitalizations for heart failure were slightly but not significantly reduced. There was also no significant effect on stable angina, stroke, and revascularizations, the authors say.
These results were observed in all subgroups of patients (hypertensive or not, diabetic or not, whatever the left ventricular ejection fraction, etc.).
The authors believe that these results would need to be confirmed by randomized trials (trials which are however unlikely to be carried out, given the age of these drugs and their already frequent use, we note) .
(JACC, vol. 81, n°24, p2299-2311)
Source: APMnews
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