Additional Coverage:
- Common heart attack drug doesn’t work and may raise risk of death for some women, new studies say (cnn.com)
Beta-Blockers After Heart Attack: New Research Suggests Not Always Beneficial
Decades-long practice may be upended by groundbreaking research questioning the routine use of beta-blockers after a heart attack. A new study, presented at the European Society of Cardiology Congress in Madrid and published in the European Heart Journal, suggests these drugs offer no benefit to most patients and may even increase risks for some women.
The study, encompassing over 8,500 men and women, revealed a concerning trend: women with minimal heart damage post-heart attack who received beta-blockers experienced significantly higher rates of subsequent heart attacks, heart failure hospitalizations, and even death compared to women who didn’t receive the drug. This effect was particularly pronounced in women receiving high doses.
Importantly, this finding applies only to women with a left ventricular ejection fraction (a measure of heart pumping ability) above 50%, considered normal function. For patients with an ejection fraction below 40%, beta-blockers remain a crucial treatment for potentially life-threatening heart arrhythmias.
While the study’s implications for women are significant, the broader findings challenge current medical guidelines. The research, part of the REBOOT clinical trial (also published in The New England Journal of Medicine), showed no overall benefit from beta-blockers in men or women with preserved heart function after a heart attack. This contradicts the 40-year standard of care that sees roughly 80% of such patients prescribed these drugs.
Experts attribute this shift to advancements in post-heart attack care, such as immediate use of stents and blood thinners. These interventions likely contribute to the higher number of patients now presenting with ejection fractions above 50%, the group for whom beta-blockers appear less beneficial.
The study’s authors emphasize the need for sex-specific approaches to cardiovascular treatment. While differences in heart size and sensitivity to blood pressure medications might play a role, more research is needed to fully understand why women might be more susceptible to adverse effects from beta-blockers.
While the REBOOT trial questioned beta-blocker use for patients with ejection fractions above 50%, a separate study published in The Lancet found benefits for those with scores between 40% and 50%. This group, experiencing mild heart damage, saw a 25% reduction in combined risk of repeat heart attacks, heart failure, and death when treated with beta-blockers.
This new research underscores the complexity of heart health and treatment, urging a re-evaluation of long-held practices and a more personalized approach to patient care.