Article Impact Level: HIGH Data Quality: STRONG Summary of Journal of the American College of Cardiology, 81(24), 2299–2311. https://doi.org/10.1016/j.jacc.2023.04.021 Dr. Lucas C. Godoy et al.
Points
- Previous studies did not find evidence of beta-blockers’ cardioprotective benefits in patients with stable coronary artery disease (CAD).
- A new user design was used to examine the association between beta-blocker use and cardiovascular events in patients with stable CAD.
- The study included over 28,000 patients aged >66 with obstructive CAD who underwent elective coronary angiography in Ontario, Canada.
- Beta-blocker usage was associated with a small but significant reduction in cardiovascular events over five years, primarily driven by decreased myocardial infarction hospitalizations.
- No significant differences were observed in all-cause mortality or heart failure hospitalizations between patients using beta-blockers and those not using them.
Summary
Previous research has yielded inconclusive results regarding the cardioprotective benefits of beta-blockers in patients with stable coronary artery disease (CAD). Using a new user design, this study investigated the association between beta-blocker usage and cardiovascular events in patients with stable CAD. The study included patients aged >66 years who underwent elective coronary angiography in Ontario, Canada, between 2009 and 2019, diagnosed with obstructive CAD. Exclusion criteria involved heart failure, recent myocardial infarction, and a beta-blocker prescription claim within the preceding year.
The primary outcome was a composite of all-cause mortality and hospitalization for heart failure or myocardial infarction. Propensity score-based inverse probability of treatment weighting was employed to adjust for confounding factors.
The study encompassed 28,039 patients (mean age: 73.0 ± 5.6 years; 66.2% male), with 12,695 (45.3%) receiving newly prescribed beta-blockers. Over a 5-year follow-up period, the risk of the primary outcome was 14.3% in the beta-blocker group compared to 16.1% in the non-beta-blocker group (absolute risk reduction: -1.8%; 95% CI: -2.8 to -0.8; HR: 0.92; 95% CI: 0.86-0.98; P = 0.006). This reduction primarily resulted from decreased hospitalizations due to myocardial infarction (cause-specific HR: 0.87; 95% CI: 0.77-0.99; P = 0.031), while no significant differences were observed in all-cause mortality or heart failure hospitalization.
Among patients with documented stable CAD, as confirmed by angiography and without heart failure or recent myocardial infarction, the utilization of beta-blockers was associated with a modest yet statistically significant decrease in cardiovascular events over five years. These findings shed new light on the potential benefits of beta-blockers in this population and emphasize their potential role in reducing myocardial infarction-related hospitalizations. Further studies are warranted to validate these results and elucidate the underlying mechanisms for these observations.
Link to the article: https://www.sciencedirect.com/science/article/abs/pii/S073510972305461X
References Godoy, L. C., Farkouh, M. E., Austin, P. C., Shah, B. R., Qiu, F., Jackevicius, C. A., Wijeysundera, H. C., Krumholz, H. M., & Ko, D. T. (2023). Association of beta-blocker therapy with cardiovascular outcomes in patients with stable ischemic heart disease. Journal of the American College of Cardiology, 81(24), 2299–2311. https://doi.org/10.1016/j.jacc.2023.04.021
