Beta-blockers: the common heart attack drug does not work and can increase the risk of death for certain women, say new studies
A class of drugs called beta -blockers – used for decades as first -line treatment after a heart attack – does not benefit the vast majority of patients and can contribute to a higher risk of hospitalization and death in certain women, but not in men, according to a new revolutionary research.
“These results will reshape all international clinical guidelines on the use of beta-blockers in men and women and should trigger a sexual and specific sex approach for cardiovascular diseases,“” The author of the main study, Dr. Valentin Fuster, president of Mount Sinai Fuster Heart Hospital in New York and Managing Director of the National Center for Cardiovascular Investigation in Madrid.
Women with little heart damage after their heart attacks that have been treated with beta -blockers were much more likely to have another heart attack or to be hospitalized for heart failure – and almost three times more likely to die – compared to women who have not given the drug, according to a study published in the European Heart Journal and also planned to be presented to be presented Saturday at the Congress of the European Cardiology Society in Madrid.
“This was particularly true for women receiving high doses of beta-blockers,” said the main study author, Dr. Borja Ibáñez, scientific director of the Madrid National Center for the cardiovascular survey.
“The total number of women in the clinical trial was the most important ever included in a study testing beta-blockers after a myocardial infarction (heart attack), it is therefore an important conclusion,” said Ibáñez, cardiologist at the Jiménez Díaz de Madrid university hospital.
The results, however, only apply to women with a left ventricular ejection fraction greater than 50%, Which is considered a normal function, the study said. The ejection fraction is a way to measure to what extent the left side of the heart pumps oxygenated blood throughout the body. For anyone with a score less than 40% after a heart attack, beta-blockers continue to be the level of care due to their ability to calm cardiac arrhythmias that can trigger a second event.
However, drugs can have unpleasant side effects, Dr. Andrew Freeman, director of cardiovascular prevention and well-being at National Jewish Health said in Denver.
“Medicines can cause low blood pressure, low heart rate, erectile dysfunction, fatigue and mood swings,” said Freeman, who was not involved in research. “Whenever we use these drugs, we must always balance the risks in relation to the advantages.”
Why would women be more likely to harm beta-blockers than men?
“It’s actually not surprising,” said Freeman. “The genre has a lot to do with the way people react to drugs. In many cases, women have a smaller heart. They are more sensitive to blood pressure drugs. Part of this may have to do with size, and some may have to do with other factors that we have not yet understood. ”
In fact, because the first research on the heart has focused on men, it took years of medical science to discover that heart disease is presented differently in women. Men generally have an accumulation of plaque in their major arteries and experience more traditional signs of a heart attack such as chest pain. Women are more likely to have a plate in small blood vessels of the heart and can have more unusual symptoms of a heart attack such as back pain, indigestion and shortness of breath.
The analysis on women was part of a much larger clinical trial called restart – treatment with beta -blockers after myocardial infarction without a reduced ejection fraction – which followed 8,505 men and women treated for heart attacks in 109 hospitals in Spain and Italy for almost four years.
The results of the study were published in the New England Journal of Medicine and also presented at the Congress of the European Cardiology Society.
None of the trial patients had a left ventricular ejection fraction of less than 40%, a sign of potential heart failure.
“We have not found any advantage in using beta-blockers for men or women with a cardiac function preserved after a heart attack despite the norm of care for about 40 years,” said Fuster, former editor in chief of the Journal of the American College of Cardiology and former president of the American Heart Association and the World Health Federation.
This is probably due to the progress of the treatment of drugs such as the immediate use of stents and anticoagulants after the arrival of patients in the hospital. In fact, most men and women who survive heart attacks today have ejection fractions greater than 50%, said Ibáñez.
“However, at present, some 80% of patients in the United States, Europe and Asia are treated with beta-blockers because medical guidelines are still recommending,” he said. “Although we often test new drugs, it is much less common to rigorously question the continuous need for older treatments.”
Although the study did not find any need to use beta-blockers for people with a left ventricular ejeure fraction greater than 50% after a heart attack, a distinct meta-analysis Of 1,885 patients published on Saturday in Lancet found advantages for those who have scores between 40% and 50%, in which the heart can be slightly damaged.
“This subgroup has benefited from a routine use of beta-blockers,” said Ibáñez, who was also co-author on this document. “We found a reduction of approximately 25% of the primary evaluation criterion, which was a composite of new heart attacks, heart failure and death all causes.”
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