Are beta blockers still the best treatment for cardiovascular disease?
Beta blockers are commonly given to patients with cardiovascular disease, but a new study published in The New England Journal of Medicine in April suggests that beta blockers might not be much help to some patients. The study included just over 5,000 people who specifically had preserved ejection fraction after a heart attack. It found that long-term treatment with beta blockers did not significantly reduce the risk of either death or another heart attack.
Over the course of an average of three and a half years, people in the study on a beta blocker had a four percent lower risk of death or heart attack than those who didn’t take the drug. That number is not considered to be statistically significant.
Cardiologist Peter Chiotellis, MD, at the Heart Center in Hyannis said the study findings are at odds with the standard of care for heart attack patients. He practices guideline-based medicine, which is considered the gold standard of care.
“Obviously this goes against a lot of what we do now within the guidelines,” Dr. Chiotellis said.
That said, he was willing to talk about the pros and cons of the study. One of the strengths of the reasoning behind the study is that since the original beta blocker studies were done, heart medicine has made huge advances in treatments over the years.
“The studies on beta blockers were done before we had more advanced modalities for the treatment of myocardial infarctions like stenting and angioplasty,” he said. “Back then, people weren’t being revascularized, meaning they have a blockage and they get a stent and then they get a restoration of blood flow.”
The drawbacks of the study, according to Dr. Chiotellis, include:
- It was a smaller trial.
- It wasn’t a double-blinded trial.
- The patients it looked at were lower risk.
- It didn’t look at patients who didn’t go to the cardiac catheterization lab for a stent.
- It was a very specific patient population.
“Maybe with the advanced therapies that we have now, like stenting, beta blockers aren’t as important in the people with normal heart function, but we do know that people with heart failure and reduced heart function and reduced ejection fraction do benefit from beta blockers,” he said.
Will Watch for More Information
He acknowledges that the medication burden is a concern for people and that beta blockers are the one medication patients are given after a heart attack that people tolerate the least. Beta blockers can cause extreme fatigue and erectile dysfunction. There are both long-acting and short-acting beta blockers. Dr. Chiotellis prescribes the longer-acting prescription and recommends taking it at night to lessen the fatigue side effects.
Dr. Chiotellis still plans to prescribe beta blockers according to the guidelines, but he will watch for future larger studies on the topic.
“Beta blockers have been around for so long that we’re so used to using them, but it is eye opening and I’m sure there will be other studies that are spawned off looking at this,” he said. “To the extent that we’ve become much more advanced in cardiology I think we just have to reevaluate medications that were used in older trials before we had these more advanced therapies. I think that’s the take-home message.”
