A new study conducted by researchers in the Cardiac and Vascular Institute at NYU Langone Medical Center, found using beta-blockers, the standard of care for patients with coronary artery disease (CAD), was not associated with a lower risk of heart attacks, death and strokes in patients suffering from CAD and those with risk factors for the disease, including those with a history of heart attack. The study appears in the October 3 issue of JAMA (Journal of the American Medical Association).
"The current standard of care for patients with coronary artery disease, especially when they have had a heart attack, is treatment with beta-blockers. However, this guidance has been extrapolated from older studies," said lead author Sripal Bangalore, MD, assistant professor in the Department of Medicine, the Leon H. Charney Division of Cardiology. "Our results found none of the patient populations studied showed benefit from taking beta-blockers, including patients with a history of heart attack. This is concerning in light of current treatment patterns and reveals a need for more education among practitioners who treat patients at risk for heart attack and stroke."
According to the American Heart Association, coronary artery disease is the leading cause of death among both men and women in the United States. Men over the age of 65 are the largest CAD segment, however, women also suffer from the disease at high rates. Risk factors for developing CAD include high blood pressure, smoking, high cholesterol, stress and poor diet.
The study, an observational analysis of more than 40,000 patients, was designed to assess the association between beta-blocker use and long-term cardiovascular outcomes including cardiovascular death, nonfatal heart attack or nonfatal stroke. The patients studied were separated into three groups including those who suffered from a prior heart attack (31 percent), those who had CAD but no prior heart attack (27 percent) and those who had CAD risk factors only (42 percent), such as high blood pressure, diabetes and smoking.
"Our findings reinforce the need for additional research assessing which patient populations show clear benefit from beta-blocker therapy, especially because side-effects from treatment can be considerable in some patients," said Dr. Bangalore. "In addition, further study needs to be conducted to assess optimal duration of therapy in these patient sub-sets."
Side effects from beta-blockers can include fatigue, headache and upset stomach, explains Bangalore, as well as increased cholesterol levels and weight gain, which is especially troubling in patients trying to reduce risk factors for CAD through lifestyle changes like weight loss and increased exercise.
All patients included in the analysis were enrolled in the Reduction of Atherothrombosis for Continued Health (REACH) registry. Patients were followed for 44 months with data continually being collected, with the last data collection in April 2009.
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