Skip to main content
Log in

β-Blockers after Acute Myocardial Infarction in Elderly Patients with Diabetes Mellitus

Time to Reassess

  • Leading Article
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

β-Blockers effectively reduce mortality and recurrent cardiovascular events in patients surviving myocardial infarction. However, these agents are underused in clinical practice, especially in older patients with diabetes mellitus. The current literature shows that β-blockers are at least as effective in older diabetic patients as in other patients, without major safety concerns for their possible adverse effects. The use of these agents in clinical practice should therefore be encouraged, in order to reduce the burden of cardiovascular mortality and morbidity in older diabetic patients post-infarction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Table I
Table II
Table III

Similar content being viewed by others

References

  1. Berger AK, Breall JA, Gersh BJ, et al. Effect of diabetes mellitus and insulin use on survival after acute myocardial infarction in the elderly (the Cooperative Cardiovascular Project). Am J Cardiol 2001; 87(3): 272–7

    Article  PubMed  CAS  Google Scholar 

  2. Abrahamsson P, Dellborg M, Rosengren A, et al. Improved long-term prognosis after myocardial infarction 1984–1991. Eur Heart J 1998; 19(10): 1512–7

    Article  PubMed  CAS  Google Scholar 

  3. Ryan TJ, Antman EM, Brooks NH, et al. 1999 update: ACC/AHA Guidelines for the management of patients with acute myocardial infarction: executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). Circulation 1999; 100(9): 1016–30

    Article  PubMed  CAS  Google Scholar 

  4. Aronow WS. Postinfarction use of beta-blockers in elderly patients. Drugs Aging 1997; 11(6): 424–32

    Article  PubMed  CAS  Google Scholar 

  5. Yusuf S, Wittes J, Friedman L. Overview of results of randomized clinical trials in heart disease. I. Treatments following myocardial infarction. JAMA 1988; 260(14): 2088–93

    Article  PubMed  CAS  Google Scholar 

  6. Yusuf S, Peto R, Lewis J, et al. Beta blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis 1985; 27(5): 335–71

    Article  PubMed  CAS  Google Scholar 

  7. Krumholz HM, Radford MJ, Wang Y, et al. National use and effectiveness of beta-blockers for the treatment of elderly patients after acute myocardial infarction: National Cooperative Cardiovascular Project. JAMA 1998; 280(7): 623–9

    Article  PubMed  CAS  Google Scholar 

  8. Beck CA, Lauzon C, Eisenberg MJ, et al. Discharge prescriptions following admission for acute myocardial infarction at tertiary care and community hospitals in Quebec. Can J Cardiol 2001; 17(1): 33–40

    PubMed  CAS  Google Scholar 

  9. Younis N, Burnham P, Patwala A, et al. Beta blocker prescribing differences in patients with and without diabetes following a first myocardial infarction. Diabet Med 2001; 18(2): 159–61

    Article  PubMed  CAS  Google Scholar 

  10. Nicholls SJ, McElduff P, Dobson AJ, et al. Underuse of beta-blockers following myocardial infarction: a tale of two cities. Intern Med J 2001; 31(7): 391–6

    Article  PubMed  CAS  Google Scholar 

  11. Soumerai SB, McLaughlin TJ, Spiegelman D, et al. Adverse outcomes of underuse of beta-blockers in elderly survivors of acute myocardial infarction. JAMA 1997; 277(2): 115–21

    Article  PubMed  CAS  Google Scholar 

  12. Gottlieb SS, McCarter RJ, Vogel RA. Effect of beta-blockade on mortality among high-risk and low-risk patients after myocardial infarction. N Engl J Med 1998; 339(8): 489–97

    Article  PubMed  CAS  Google Scholar 

  13. Barakat K, Wilkinson P, Deaner A, et al. How should age affect management of acute myocardial infarction? A prospective cohort study. Lancet 1999; 353(9157): 955–9

    Article  PubMed  CAS  Google Scholar 

  14. Malmberg K, Herlitz J, Hjalmarson A, et al. Effects of metoprolol on mortality and late infarction in diabetics with suspected acute myocardial infarction. Retrospective data from two large studies. Eur Heart J 1989; 10(5): 423–8

    PubMed  CAS  Google Scholar 

  15. Randomised trial of intravenous atenolol among 16 027 cases of suspected acute myocardial infarction: ISIS-1. First International Study of Infarct Survival Collaborative Group. Lancet 1986; 2(8498): 57–66

    Google Scholar 

  16. Gundersen T, Kjekshus J. Timolol treatment after myocardial infarction in diabetic patients. Diabetes Care 1983; 6(3): 285–90

    Article  PubMed  CAS  Google Scholar 

  17. A randomized trial of propranolol in patients with acute myocardial infarction. I. Mortality results. JAMA 1982; 247(12): 1707–14

    Google Scholar 

  18. The effect of pindolol on the two years mortality after complicated myocardial infarction. Eur Heart J 1983; 4(6): 367–75

    Google Scholar 

  19. Kjekshus J, Gilpin E, Cali G, et al. Diabetic patients and beta-blockers after acute myocardial infarction. Eur Heart J 1990; 11(1): 43–50

    PubMed  CAS  Google Scholar 

  20. MacDonald TM, Butler R, Newton RW, et al. Which drugs benefit diabetic patients for secondary prevention of myocardial infarction? DARTS/MEMO Collaboration. Diabet Med 1998; 15(4): 282–9

    Article  PubMed  CAS  Google Scholar 

  21. Kendall MJ, Lynch KP, Hjalmarson A, et al. Beta-blockers and sudden cardiac death. Ann Intern Med 1995; 123(5): 358–67

    PubMed  CAS  Google Scholar 

  22. Jonas M, Reicher-Reiss H, Boyko V, et al. Usefulness of beta-blocker therapy in patients with non-insulin-dependent diabetes mellitus and coronary artery disease. Bezafibrate Infarction Prevention (BIP) Study Group. Am J Cardiol 1996; 77(15): 1273–7

    Article  PubMed  CAS  Google Scholar 

  23. Chen J, Marciniak TA, Radford MJ, et al. Beta-blocker therapy for secondary prevention of myocardial infarction in elderly diabetic patients. Results from the National Cooperative Cardiovascular Project. J Am Coll Cardiol 1999; 34(5): 1388–94

    Article  PubMed  CAS  Google Scholar 

  24. Löwel H, Koenig W, Engel S, et al. The impact of diabetes mellitus on survival after myocardial infarction: can it be modified by drug treatment?. Results of a population-based myocardial infarction register follow-up study. Diabetologia 2000; 43(2): 218–26

    Article  PubMed  Google Scholar 

  25. Aronow WS, Ahn C. Effect of beta blockers on incidence of new coronary events in older persons with prior myocardial infarction and diabetes mellitus. Am J Cardiol 2001; 87(6): 780–1, A8

    Article  PubMed  CAS  Google Scholar 

  26. Fihn SD, Williams SV, Daley J, et al. Guidelines for the management of patients with chronic stable angina: treatment. Ann Intern Med 2001; 135 (8 Pt 1): 616–32

    PubMed  CAS  Google Scholar 

  27. The Sixth Report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med 1997; 157(21): 2413–46

    Google Scholar 

  28. Medical Research Council Working Party. MRC trial of treatment of mild hypertension: principal results. BMJ 1985; 291(6488): 97–104

    Article  Google Scholar 

  29. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991; 265(24): 3255–64

    Article  Google Scholar 

  30. Dahlof B, Lindholm LH, Hansson L, et al. Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension). Lancet 1991; 338(8778): 1281–5

    Article  PubMed  CAS  Google Scholar 

  31. Maki M, Nuutila P, Laine H, et al. Myocardial glucose uptake in patients with NIDDM and stable coronary artery disease. Diabetes 1997; 46(9): 1491–6

    Article  PubMed  CAS  Google Scholar 

  32. Nuutila P, Knuuti J, Ruotsalainen U, et al. Insulin resistance is localized to skeletal but not heart muscle in type 1 diabetes. Am J Physiol 1993; 264 (5 Pt 1): E756–62

    PubMed  CAS  Google Scholar 

  33. Opie LH, Thomas M. Propranolol and experimental myocardial infarction: substrate effects. Postgrad Med J 1976; 52Suppl. 4: 124–32

    PubMed  Google Scholar 

  34. Wallhaus TR, Taylor M, DeGrado TR, et al. Myocardial free fatty acid and glucose use after carvedilol treatment in patients with congestive heart failure. Circulation 2001; 103(20): 2441–6

    Article  PubMed  CAS  Google Scholar 

  35. Opie LH. Metabolism of free fatty acids, glucose and catecholamines in acute myocardial infarction: relation to myocardial ischemia and infarct size. Am J Cardiol 1975; 36(7): 938–53

    Article  PubMed  CAS  Google Scholar 

  36. Ewing DJ. Diabetic autonomic neuropathy and the heart. Diabetes Res Clin Pract 1996; 30Suppl. 31 (6): 31–6

    Article  PubMed  Google Scholar 

  37. Bigger Jr JT, Fleiss JL, Rolnitzky LM, et al. Frequency domain measures of heart period variability to assess risk late after myocardial infarction. J Am Coll Cardiol 1993; 21(3): 729–36

    Article  PubMed  Google Scholar 

  38. Herlitz J, Hartford M, Pennert K, et al. Goteborg Metoprolol Trial: clinical observations. Am J Cardiol 1984; 53(13): 37D–45D

    PubMed  CAS  Google Scholar 

  39. Olsson G, Wikstrand J, Warnold I, et al. Metoprolol-induced reduction in postinfarction mortality: pooled results from five double-blind randomized trials. Eur Heart J 1992; 13(1): 28–32

    PubMed  CAS  Google Scholar 

  40. Hjalmarson A. Cardioprotection with beta-adrenoceptor blockers: does lipophilicity matter? Basic Res Cardiol 2000; 95Suppl. 1: I41–5

    Article  PubMed  Google Scholar 

  41. Hilleman DE, Bauman AL. Role of antiarrhythmic therapy in patients at risk for sudden cardiac death: an evidence-based review. Pharmacotherapy 2001; 21(5): 556–75

    Article  PubMed  CAS  Google Scholar 

  42. Andreka P, Aiyar N, Olson LC, et al. Bucindolol displays intrinsic sympathomimetic activity in human myocardium. Circulation 2002; 105(20): 2429–34

    Article  PubMed  CAS  Google Scholar 

  43. Goldstein S. Benefits of beta-blocker therapy for heart failure: weighing the evidence. Arch Intern Med 2002; 162(6): 641–8

    Article  PubMed  CAS  Google Scholar 

  44. A trial of the beta-blocker bucindolol in patients with advanced chronic heart failure. N Engl J Med 2001; 344(22): 1659–67

    Google Scholar 

  45. The Xamoterol in Severe Heart Failure Study Group. Xamoterol in severe heart failure. Lancet 1990; 336(8706): 1–6

    Article  Google Scholar 

  46. Mills GA, Horn JR. Beta-blockers and glucose control. Drug Intell Clin Pharm 1985; 19(4): 246–51

    PubMed  CAS  Google Scholar 

  47. Houston MC. Adverse effects of antihypertensive drug therapy on glucose intolerance. Cardiol Clin 1986; 4(1): 117–35

    PubMed  CAS  Google Scholar 

  48. Deacon SP, Karunanayake A, Barnett D. Acebutolol, atenolol, and propranolol and metabolic responses to acute hypoglycaemia in diabetics. BMJ 1977; 2(6097): 1255–7

    Article  PubMed  CAS  Google Scholar 

  49. Shorr RI, Ray WA, Daugherty JR, et al. Incidence and risk factors for serious hypoglycemia in older persons using insulin or sulfonylureas. Arch Intern Med 1997; 157(15): 1681–6

    Article  PubMed  CAS  Google Scholar 

  50. Greene DA. Acute and chronic complications of diabetes mellitus in older patients. Am J Med 1986; 80(5A): 39–53

    Article  PubMed  CAS  Google Scholar 

  51. Cahill Jr GF. Hyperglycemic hyperosmolar coma: a syndrome almost unique to the elderly. J Am Geriatr Soc 1983; 31(2): 103–5

    PubMed  Google Scholar 

  52. Herlitz J, Hjalmarson A, Holmberg S, et al. Development of congestive heart failure after treatment with metoprolol in acute myocardial infarction. Br Heart J 1984; 51(5): 539–44

    Article  PubMed  CAS  Google Scholar 

  53. Hansteen V, Moinichen E, Lorentsen E, et al. One year’s treatment with propranolol after myocardial infarction: preliminary report of Norwegian multicentre trial. BMJ 1982; 284(310): 155–60

    Article  PubMed  CAS  Google Scholar 

  54. Hunt SA, Baker DW, Chin MH, et al. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee to revise the 1995 guidelines for the evaluation and management of heart failure). J Am Coll Cardiol 2001; 38(7): 2101–13

    Article  PubMed  CAS  Google Scholar 

  55. Rochon PA, Tu JV, Anderson GM, et al. Rate of heart failure and 1-year survival for older people receiving low-dose beta-blocker therapy after myocardial infarction. Lancet 2000; 356(9230): 639–44

    Article  PubMed  CAS  Google Scholar 

  56. Dargie HJ. Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial. Lancet 2001; 357(9266): 1385–90

    Article  PubMed  CAS  Google Scholar 

  57. Baldasseroni S, Opasich C, Gorini M, et al. Left bundle-branch block is associated with increased one-year mortality in congestive heart failure: a report from the Italian Network on Congestive Heart Failure (IN-CHF database). Am Heart J 2002; 143(3): 398–405

    Article  PubMed  Google Scholar 

  58. Lager I, Blohme G, Smith U. Effect of cardioselective and non-selective beta-blockade on the hypoglycaemic response in insulin-dependent diabetics. Lancet 1979; 1(8114): 458–62

    Article  PubMed  CAS  Google Scholar 

  59. Shorr RI, Ray WA, Daugherty JR, et al. Antihypertensives and the risk of serious hypoglycemia in older persons using insulin or sulfonylureas. JAMA 1997; 278(1): 40–3

    Article  PubMed  CAS  Google Scholar 

  60. Jacob S, Rett K, Henriksen EJ. Antihypertensive therapy and insulin sensitivity: do we have to redefine the role of beta-blocking agents? Am J Hypertens 1998; 11(10): 1258–65

    Article  PubMed  CAS  Google Scholar 

  61. Giugliano D, Acampora R, Marfella R, et al. Metabolic and cardiovascular effects of carvedilol and atenolol in non-insulin-dependent diabetes mellitus and hypertension. A randomized, controlled trial. Ann Intern Med 1997; 126(12): 955–9

    PubMed  CAS  Google Scholar 

  62. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. BMJ 1998; 317(7160): 713–20

    Article  Google Scholar 

  63. Gress TW, Nieto FJ, Shahar E, et al. Hypertension and antihypertensive therapy as risk factors for type 2 diabetes mellitus. Atherosclerosis Risk in Communities Study. N Engl J Med 2000; 342(13): 905–12

    Article  PubMed  CAS  Google Scholar 

  64. Niskanen L, Hedner T, Hansson L, et al. Reduced cardiovascular morbidity and mortality in hypertensive diabetic patients on first-line therapy With an ACE inhibitor compared with a diuretic/beta-blocker-based treatment regimen: a subanalysis of the Captopril Prevention Project. Diabetes Care 2001; 24(12): 2091–6

    Article  PubMed  CAS  Google Scholar 

  65. Prichard BN, Graham BR, Cruickshank JM. New approaches to the uses of beta blocking drugs in hypertension. J Hum Hypertens 2000; 14Suppl 1: S63–8: S63-8

    Article  PubMed  CAS  Google Scholar 

  66. Hollenberg NK, Williams GH, Anderson R. Medical therapy, symptoms, and the distress the cause: relation to quality of life in patients with angina pectoris and/or hypertension. Arch Intern Med 2000; 160(10): 1477–83

    Article  PubMed  CAS  Google Scholar 

  67. Perez-Stable EJ, Halliday R, Gardiner PS, et al. The effects of propranolol on cognitive function and quality of life: a randomized trial among patients with diastolic hypertension. Am J Med 2000; 108(5): 359–65

    Article  PubMed  CAS  Google Scholar 

  68. Paran E, Anson O, Neumann L. The effects of replacing beta-blockers with an angiotensin converting enzyme inhibitor on the quality of life of hypertensive patients. Am J Hypertens 1996; 9 (12 Pt 1): 1206–13

    Article  PubMed  CAS  Google Scholar 

  69. Lewis CE, Grandits A, Flack J, et al. Efficacy and tolerance of antihypertensive treatment in men and women with stage 1 diastolic hypertension: results of the Treatment of Mild Hypertension Study. Arch Intern Med 1996; 156(4): 377–85

    Article  PubMed  CAS  Google Scholar 

  70. Applegate WB, Pressel S, Wittes J, et al. Impact of the treatment of isolated systolic hypertension on behavioral variables: results from the systolic hypertension in the elderly program. Arch Intern Med 1994; 154(19): 2154–60

    Article  PubMed  CAS  Google Scholar 

  71. Ekman M, Zethraeus N, Jonsson B. Cost effectiveness of bisoprolol in the treatment of chronic congestive heart failure in Sweden: analysis using data from the Cardiac Insufficiency Bisoprolol Study II trial. Pharmacoeconomics 2001; 19(9): 901–16

    Article  PubMed  CAS  Google Scholar 

  72. Dahlof C, Dimenas E, Kendall M, et al. Quality of life in cardiovascular diseases. Emphasis on beta-blocker treatment. Circulation 1991; 84 (6 Suppl.): VI108–18

    PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors have no conflicts of interest directly relevant to the content of this review. Supported by grant 5 P60 AG10484 from Claude D. Pepper Older Americans’ Independence Center.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mauro Di Bari.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Di Bari, M., Marchionni, N. & Pahor, M. β-Blockers after Acute Myocardial Infarction in Elderly Patients with Diabetes Mellitus. Drugs Aging 20, 13–22 (2003). https://doi.org/10.2165/00002512-200320010-00002

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00002512-200320010-00002

Keywords

Navigation