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- Title
Effectiveness of beta blockers in patients with and without a history of myocardial infarction.
- Authors
Verma, Sanjay; Peterson, Edward L.; Liu, Bin; Sabbah, Hani N.; Williams, L. Keoki; Lanfear, David E.
- 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.
- Subjects
ADRENERGIC beta blockers; CORONARY disease; CAUSES of death; LONGITUDINAL method; MYOCARDIAL infarction; RISK assessment; TIME; RELATIVE medical risk; PROPORTIONAL hazards models; RETROSPECTIVE studies; DESCRIPTIVE statistics; ODDS ratio
- Publication
European Journal of Clinical Pharmacology, 2020, Vol 76, Issue 8, p1161
- ISSN
0031-6970
- Publication type
Article
- DOI
10.1007/s00228-020-02886-0