According to the American Heart Association (AHA), heart attacks are a leading cause of death, and more than 600.000 people experience their first attack every year. Researchers conducted a trial to determine whether the standard practice of prescribing beta-blockers after a heart attack improved the risk of a future cardiovascular event or death.
Prescribing beta blockers within the circumstance is a common practice, but some experts believe that it needs to be updated. In the REDUCE-AMI trial, the scientists randomly assigned participants to receive a beta-blocker after they were diagnosed with preserved ejection fraction following a heart attack, also called a myocardial infarction. The findings showed no significant difference in cardiovascular outcomes between the beta-blockers and no-beta-blockers groups.
According to a study published in the New England Journal of Medicine, beta blockers are commonly prescribed following a heart attack to reduce the risk of a subsequent cardiovascular event. A heart attack occurs when a blockage within the coronary artery causes a lack of blood flow to part of the heart. Coronary heart disease, a buildup of plaque in the arteries, causes heart attacks. One way to measure someone’s heart health is ejection fraction, which refers to how well the heart’s left ventricle pushes out blood. If someone’s measurement is low, it can indicate heart failure.Â
In the REDUCE-AMI trial, scientists wanted to find out if beta-blockers reduce the risk of death or another heart attack in people who had a heart attack but still had an average ejection fraction. This trial recruited 5020 people from 45 healthcare centers to participate in the study. In addition to needing an average heart ejection fraction, participants also had to have a coronary angiography during their hospital stay.Â
The scientists randomly assigned which participants would take a beta-blocker (metoprolol or bisoprolol) as a long-term treatment and had a median follow-up of 3.5 years. It was seen that beta blockers provided no overall benefit to participants. In the beta-blocker group, 7.9% of the participants experienced the ‘primary outcome’ of a new heart attack. This was slightly lower than the primary outcomes in the no-beta-blockers group, which was 8.3% of the participants either dying or having a new heart attack.Â
The researchers also saw no improvement in the risk of death from cardiovascular causes or hospitalizations for atrial fibrillation (AFib) and heart failure in people who took beta-blockers.Â
These findings challenge the conventional belief that beta-blockers are universally beneficial after a heart attack. A limitation of the research is that it was an open study versus placebo-controlled, but that should not “affect the primary outcome, death or new myocardial infarction. Patients who experience heart attacks might be receiving new medicines as part of a new drug regimen. These patients sometimes have difficulty managing all of these new medicines, and streamlining un-beneficial drugs can help patients improve their compliance with a new regimen.Â
Journal Reference – Yndigegn, T., Lindahl, B., Mars, K., Alfredsson, J., Benatar, J., Brandin, L., … Jernberg, T. (2024). New England Journal of Medicine. doi:10.1056/nejmoa2401479Â
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