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Effectiveness of beta blockers in patients with and without a history of myocardial infarction

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

Studies demonstrating mortality benefit of beta blockers (BB) after myocardial infarction (MI) were conducted before the era of percutaneous intervention and widespread use of statins. Recent retrospective studies show inconsistent results regarding which subgroups of coronary artery disease (CAD) patients’ benefit. Most studies did not account for medication changes over time. We evaluated the association of time-varying BB exposure with death in CAD patients with or without a history of MI.

Methods

This retrospective cohort study included all patients with MI and those with coronary disease but no MI at a single health care system who also had health insurance from January 1, 1997, to June 30, 2011. Pharmacy claims data were used to estimate BB exposure over 6-month rolling windows. The primary endpoint was all-cause death. The effect of BB exposure was tested using time-updated Cox proportional hazards models.

Results

We identified 6220 patients with MI and 21,285 patients with CAD but no MI. Among patients who suffered MI, BB exposure was associated with a 31% relative risk reduction in all-cause death (hazard ratio [HR] 0.69, P = 0.001). Among subjects who survived 3 years after MI, BB retained a protective association (HR 0.71, P = 0.001). Among CAD-only patients, BB exposure was also associated with risk reduction (HR 0.85, P = 0.001).

Conclusion

Among patients with CAD, BB exposure is associated with reduced risk of death. The association is strongest among those who have suffered MI. This favorable association appears durable beyond 3 years.

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Funding

This study was funded by the NIH grant number R01HL132154.

Author information

Authors and Affiliations

  1. Heart and Vascular Institute, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA

    Sanjay Verma, Hani N. Sabbah & David E. Lanfear

  2. Department of Public Health Sciences, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA

    Edward L. Peterson & Bin Liu

  3. Center for Individualized and Genomic Medicine Research, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA

    L. Keoki Williams & David E. Lanfear

Authors
  1. Sanjay Verma
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  2. Edward L. Peterson
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  3. Bin Liu
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  4. Hani N. Sabbah
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  5. L. Keoki Williams
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  6. David E. Lanfear
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Contributions

The authors are solely responsible for the design and conduct of this study, all study analyses, and drafting and editing of the paper.

Sanjay Verma: Study concept and design; acquisition, analysis, or interpretation of data; drafting of the manuscript; and critical revision of the manuscript for important intellectual content.

Edward L. Peterson: Acquisition, analysis, or interpretation of data and critical revision of the manuscript for important intellectual content.

Bin Liu: Acquisition, analysis, or interpretation of data and critical revision of the manuscript for important intellectual content.

Hani N. Sabbah: Acquisition, analysis, or interpretation of data and critical revision of the manuscript for important intellectual content.

L. Keoki Williams: Acquisition, analysis, or interpretation of data and critical revision of the manuscript for important intellectual content.

David E. Lanfear: Study concept and design; acquisition, analysis, or interpretation of data; drafting of the manuscript; and critical revision of the manuscript for important intellectual content.

Corresponding author

Correspondence to David E. Lanfear.

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Conflict of interest

The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (including name of committee + reference number) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was originally waived for this study.

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Verma, S., Peterson, E.L., Liu, B. et al. Effectiveness of beta blockers in patients with and without a history of myocardial infarction. Eur J Clin Pharmacol 76, 1161–1168 (2020). https://doi.org/10.1007/s00228-020-02886-0

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  • DOI: https://doi.org/10.1007/s00228-020-02886-0

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