Common Heart Medication May Be Ineffective for Many

Women who had normal cardiac function after a heart attack and were treated with beta-blockers experienced more adverse events, including a 2.7 percent higher absolute risk of mortality, compared with those not treated with beta-blockers, according to the study’s data. 

Beta-blockers are some of the most prescribed medications in the U.S. It’s estimated that 1 in 10 Americans take them, according to the Cleveland Clinic. However, the study’s authors say the latest findings could reshape future clinical guidelines.

Worse for women

A sub-study published simultaneously in the European Heart Journal concluded the beta-blocker study’s data showed gender-based differences and suggested the need for sex-specific guidelines in heart attack care.

Through a series of follow-up appointments, researchers measured the number of deaths, additional heart attacks and heart failure hospitalizations, as well as other outcomes like cardiac death, stroke and arrhythmias.

Beta-blockers were associated with more harm in women, especially those on higher doses. Men did not show the same risks.

Medical advances reduce reliance on beta-blockers  

Beta-blockers have been the main line of defense against heart attacks for nearly half a century. Today, though, doctors have more options — like opening arteries with stents and balloons or using medications to dissolve blood clots and lower cholesterol — to help lower the risk of serious complications.

“Our results simply reflect how medicine evolves — what was once a lifesaving therapy in a different clinical era has become unnecessary” now that doctors have other ways to treat heart attacks and prevent future events, Ibáñez said. This has opened research to investigate whether beta-blockers are still necessary as a line of defense.

It’s important to note that the studies were designed to investigate whether beta-blockers are still necessary when heart function remains normal or is mildly impaired after a heart attack. The findings do not apply to patients who experience more serious damage.

“Beta-blockers are unequivocally beneficial and lifesaving. We know beta-blockers are the single most effective medication for individuals with heart failure and where their heart function is not normal,” said Dr. Gregg Fonarow, interim chief of cardiology at the University of California, Los Angeles.

He said that the results in these new studies have shown discrepancies and that not every large clinical trial provides a definitive answer.

For now, Fonarow will continue to prescribe beta-blockers to his patients. “This is a well-established medication that may have additional benefits, and we should really be sure that there are no benefits if we’re going to substantially change practice,” he said.

What to ask your doctor

Wondering if you should be taking beta-blockers? First, know that you should never stop a medication without speaking to your doctor.

“At [your] next routine appointment — this is not an urgent issue — you should ask whether you are taking beta-blockers solely because of a prior [heart attack] and whether your cardiac function is normal,” Ibáñez said. “If both conditions apply, it is very likely that your physician will recommend discontinuation.”

Fonarow said, “The key is knowing what their ongoing risk factors are and knowing what their heart function is.”

It’s also important to ask your clinician why you take certain medications and what they’re doing. This can then lead to a conversation about whether you need to continue.

“Beta-blockers are not a medication that should just be abruptly stopped without careful consideration and discussion with a physician who knows the patient best,” Fonarow said.