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- Title
β-Blockers and Progression of Coronary Atherosclerosis: Pooled Analysis of 4 Intravascular Ultrasonography Trials.
- Authors
Sipahi, Ilke; Tuzcu, E. Murat; Wolski, Katherine E.; Nicholls, Stephen J.; Schoenhagen, Paul; Hu, Bo; Balog, Craig; Shishehbor, Mehdi; Magyar, William A.; Crowe, Timothy D.; Kapadia, Samir; Nissen, Steven E.
- Abstract
Background: In patients with myocardial infarction, β-adrenergic blockers reduce recurrent myocardial infarction and total mortality rates. However, whether a direct influence of β-blockers on coronary atherosclerosis contributes to reduced recurrent myocardial infarction and total mortality rates is not known. Objective: To assess whether β-blocker therapy is associated with reduced atheroma progression in adults with known coronary artery disease. Design: Post hoc, pooled analysis of individual patient data from 4 intravascular ultrasonography (IVUS) trials. Setting: Four IVUS trials conducted in the United States, Europe, and Australia. Patients: 1515 patients with coronary artery disease. Intervention: The original trials used 3 different statins, a calciumchannel blocker, an angiotensin-converting enzyme inhibitor, or an acyl coenzyme A—cholesterol acyltransferase inhibitor. Measurements: Changes in atheroma volume, as determined by IVUS after adjustment for possible confounders by using linear mixed-effects models, were compared in patients who did and did not receive concomitant β-blocker treatment. Results: Patients who received β-blockers (n = 1154) were more likely to have histories of myocardial infarction, angina, and hypertension than were patients who did not receive β-blockers (n = 361). The estimated annual change in atheroma volume was statistically significantly less in patients who received β-blockers. This was true for univariate and multivariable analyses that controlled for history of myocardial infarction, angina, and hypertension (mean [±SE] atheroma volume, -2.4 ± 0.5 mm³/y in treated patients vs. -0.4 ± 0.8 mm³/y in untreated patients; P < 0.034). Accordingly, atheroma volume statistically significantly decreased at follow-up IVUS in patients who received β-blockers (P = 0.001) and did not change in patients who did not receive β-blockers (P = 0.86). Additional adjustments for low-density lipoprotein cholesterol level, concomitant medications, and clinical trial did not change the results. Limitations: Patients were not randomly assigned to β-blocker therapy, and interventions other than β-blocker therapy could have influenced the changes in atheroma volume. Whether progression rate of atherosclerosis as detected by IVUS predicts cardiovascular outcomes is unknown. Conclusions: The analysis demonstrates that β-blockers can slow progression of coronary atherosclerosis. The findings provide additional support for the current clinical guidelines advocating longterm use of β-blockers to treat most forms of coronary artery disease.
- Subjects
MYOCARDIAL infarction; ATHEROSCLEROSIS; ATHEROSCLEROTIC plaque; INTRAVASCULAR ultrasonography; CLINICAL trials
- Publication
Annals of Internal Medicine, 2007, Vol 147, Issue 1, p10
- ISSN
0003-4819
- Publication type
Article
- DOI
10.7326/0003-4819-147-1-200707030-00003