Effect of Beta-Blocker on Long-Term Major Cardiovascular Events in High Atherosclerotic Risk Population.

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiovascular Drugs and Therapy Pub Date : 2024-12-01 Epub Date: 2023-08-18 DOI:10.1007/s10557-023-07502-8

Nichanan Osataphan, Kamol Udol, Khanchai Siriwattana, Bancha Sukanandachai, Siriluck Gunaparn, Wachiranun Sirikul, Arintaya Phrommintikul, Wanwarang Wongcharoen

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Abstract

Purpose: Beta-blocker is a frequently used medication in cardiovascular diseases. However, long-term benefit of beta-blocker in patients with preserved left ventricular ejection function (LVEF) on major adverse cardiovascular events (MACEs) is uncertain.

Methods: The Cohort Of patients with high Risk for cardiovascular Events (CORE-Thailand) was a prospective study that enrolled Thai patients with high atherosclerotic risk including multiple atherosclerotic risk factors and established atherosclerotic cardiovascular diseases. Baseline demographic data, co-morbidities and medication were recorded. Patients were followed for 5 years. Patients with LVEF<50% were excluded. Primary outcome was the effect of beta-blocker on the occurrence of MACEs including all-cause death, non-fatal myocardial infarction and non-fatal stroke (3P-MACEs). Propensity score matching was used to control confounding factors.

Results: There was a total of 8513 patients in the pre-matched cohort, 4418 were taking beta-blocker and 4095 were not. After adjustment of confounders, beta-blocker was an independent predictor of 3P-MACEs (adjusted HR 1.29;95% CI 1.12-1.49;p<0.001). After propensity score matching, 4686 patients remained in the post-matched cohort. Propensity score analysis showed consistent results in which patient taking beta-blocker had higher risk of 3P-MACEs (adjusted HR 1.29;95% CI 1.10-1.53;p=0.002). Subgroup analysis in patients with coronary artery disease (CAD) indicated that taking beta-blocker did not increase the incidence of 3P-MACEs (adjusted HR 0.99;95% CI 0.76-1.29) while those without CAD did (adjusted HR 1.51; 95% CI, 1.22-1.86;p-interaction=0.015).

Conclusion: In patients with high atherosclerotic cardiovascular risk, taking beta-blockers had a higher risk of 3P-MACEs. Care should be taken when prescribing beta-blockers to patients without a clear indication.

Trial registration: TCTR20130520001 registered in Thai Clinical Trials Registry (TCTR) https://www.thaiclinicaltrials.org/ , date of registration 20 May 2013.

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受体阻滞剂对动脉粥样硬化高危人群长期主要心血管事件的影响。

目的：受体阻滞剂是心血管疾病的常用药物。然而，对于保留左心室射血功能（LVEF）的患者，β受体阻滞剂对主要不良心血管事件（mace）的长期益处尚不确定。方法：心血管事件高风险患者队列（CORE-Thailand）是一项前瞻性研究，纳入了包括多种动脉粥样硬化危险因素和已确定的动脉粥样硬化性心血管疾病的高动脉粥样硬化风险泰国患者。记录基线人口统计数据、合并症和用药情况。随访5年。结果：在预匹配队列中，共有8513例患者，4418例服用β受体阻滞剂，4095例未服用。调整混杂因素后，β受体阻滞剂是3p - mace的独立预测因子（调整后的HR为1.29；95% CI为1.12-1.49）。结论：在动脉粥样硬化性心血管风险高的患者中，服用β受体阻滞剂有更高的3p - mace风险。在给没有明确适应症的患者开β受体阻滞剂处方时应小心。试验注册：TCTR20130520001在泰国临床试验注册中心（TCTR） https://www.thaiclinicaltrials.org/注册，注册日期为2013年5月20日。

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来源期刊

Cardiovascular Drugs and Therapy 医学-心血管系统

CiteScore

8.30

自引率

0.00%

发文量

110

审稿时长

4.5 months

期刊介绍： Designed to objectively cover the process of bench to bedside development of cardiovascular drug, device and cell therapy, and to bring you the information you need most in a timely and useful format, Cardiovascular Drugs and Therapy takes a fresh and energetic look at advances in this dynamic field. Homing in on the most exciting work being done on new therapeutic agents, Cardiovascular Drugs and Therapy focusses on developments in atherosclerosis, hyperlipidemia, diabetes, ischemic syndromes and arrhythmias. The Journal is an authoritative source of current and relevant information that is indispensable for basic and clinical investigators aiming for novel, breakthrough research as well as for cardiologists seeking to best serve their patients. Providing you with a single, concise reference tool acknowledged to be among the finest in the world, Cardiovascular Drugs and Therapy is listed in Web of Science and PubMed/Medline among other abstracting and indexing services. The regular articles and frequent special topical issues equip you with an up-to-date source defined by the need for accurate information on an ever-evolving field. Cardiovascular Drugs and Therapy is a careful and accurate guide through the maze of new products and therapies which furnishes you with the details on cardiovascular pharmacology that you will refer to time and time again.