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Medicine

Beta Blockers for Heart Attack Survivors: May Have No Benefit for Most, Could Actually Harm Women (cnn.com) 126

Posted by EditorDavid from the doctors'-orders dept.
"A class of drugs called beta-blockers — used for decades as a first-line treatment after a heart attack — doesn't benefit the vast majority of patients," reports CNN. And in fact beta-blockers "may contribute to a higher risk of hospitalization and death in some women but not in men, according to groundbreaking new research..." Women with little heart damage after their heart attacks who were treated with beta-blockers were significantly more likely to have another heart attack or be hospitalized for heart failure — and nearly three times more likely to die — compared with women not given the drug, according to a study published in the European Heart Journal and also scheduled to be presented Saturday at the European Society of Cardiology Congress in Madrid... The findings, however, only applied to women with a left ventricular ejection fraction above 50%, which is considered normal function, the study said. Ejection fraction is a way of measuring how well the left side of the heart is pumping oxygenated blood throughout the body. For anyone with a score below 40% after a heart attack, beta-blockers continue to be the standard of care due to their ability to calm heart arrhythmias that may trigger a second event...

The analysis on women was part of a much larger clinical trial called REBOOT — Treatment with Beta-Blockers after Myocardial Infarction without Reduced Ejection Fraction — which followed 8,505 men and women treated for heart attacks at 109 hospitals in Spain and Italy for nearly four years. Results of the study were published in Mem>The New England Journal of Medicine and also presented at the European Society of Cardiology Congress. None of the patients in the trial had a left ventricular ejection fraction below 40%, a sign of potential heart failure. "We found no benefit in using beta-blockers for men or women with preserved heart function after heart attack despite this being the standard of care for some 40 years," said Fuster, former editor-in-chief of the Journal of the American College of Cardiology and past president of the American Heart Association and the World Health Federation... In fact, most men and women who survive heart attacks today have ejection fractions above 50%, Ibáñez said [Dr. Borja Ibáñez, scientific director for Madrid's National Center for Cardiovascular Investigation]. "Yet at this time, some 80% of patients in the US, Europe and Asia are treated with beta-blockers because medical guidelines still recommend them...."

While the study did not find any need to use beta-blockers for people with a left ventricular ejection fraction above 50% after a heart attack, a separate meta-analysis of 1,885 patients published Saturday in The Lancet did find benefits for those with scores between 40% and 50%, in which the heart may be mildly damaged. "This subgroup did benefit from a routine use of beta-blockers," said Ibáñez, who was also a coauthor on this paper. "We found about a 25% reduction in the primary endpoint, which was a composite of new heart attacks, heart failure and all-cause death."
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Beta Blockers for Heart Attack Survivors: May Have No Benefit for Most, Could Actually Harm Women More

Beta Blockers for Heart Attack Survivors: May Have No Benefit for Most, Could Actually Harm Women

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  • Retesting old dogma... (Score:5, Informative)

    by MMC Monster ( 602931 ) on Sunday August 31, 2025 @04:14PM (#65628682)

    (I am a cardiologist)

    This is an interesting thing, and needs to be followed closely.

    There are a group of medications that have been made the standard of care for the treatment of a heart attack. These medications were tested in numerous high quality trials (randomized, double blind, placebo-control). But many of the trials are old. They don't take modern practices into account.

    The problem with "just repeat the trials" is that trials are both hard and expensive. Expensive to get enough people enrolled in them and followed for a long enough time to get a good outcome. Hard because it's hard to enroll someone who is in the acute phase of a heart attack into a trial. Doubly hard if you are trying to test something that was previously believed to be the standard of care.

    Imagine being a patient and being offered "We have this medication that we want to test whether it's going to help you after your heart attack. Would you be willing to be in a trial, where you are not sure if you are going to get the medication or not? If you don't want to be in the trial, you will almost definitely get the medication, because it's considered a lifesaving medication after a heart attack."

    These trials are great and I give props to the study authors and their team to tease out this information. It's not practice-changing... yet, but certainly challenges the idea that every patient needs a beta blocker post-myocardial infarction (heart attack).

    In reality, we are pushing more ACE-I than beta blockers on the discharge medications, but beta blockers are still on the list of required medications at the time of discharge to meet "quality of care" metrics. Maybe those metrics will get updated to be based on post-MI ejection fraction.

    • You say these studies are old... isn't it also true that a lot of older medical trials were mainly done on (white) men?

      • You say these studies are old... isn't it also true that a lot of older medical trials were mainly done on (white) men?

        To do them any other way might require diversity, equity and inclusion ... all big no-nos for the next 3.5 years. /s

        • Re: (Score:2)

          by Kokuyo ( 549451 )

          Well, go say thank you to those who abused those terms to push hatred, racism and segregation.

          Or how do you think the orange man-child was able to win two elections ont that basis? Because the topic was so unproblematic before?

          Or might it be that people felt they weren't allowed to talk about mental illness anymore and had to shut up when nutjobs with rainbow flags shoot up kids?

          And I really wish I was blowing things out of proportion. It's unbelievable with how much ibcompetence and lack of foresight the d

    • Re: (Score:2)

      by PCM2 ( 4486 )

      I remember hearing, years ago, that the EU no longer recommends beta blockers as a first-line treatment for hypertension (high blood pressure) for a similar reason: They don't seem to do anything. Sure, they lower your blood pressure numbers, but (as I recall) the meta-study showed no appreciable difference in outcomes. That is, people who received beta blockers experienced the same number of heart attacks, strokes, and other hypertension-related problems as the group that didn't take them.

      • No one has recommended beta blockers as a first line therapy for hypertension for decades.

        This article isn't about the treatment of hypertension. This article is about the treatment of the acute phase of myocardial infarction.

        Also, blood pressure lowering (regardless of the medication used) absolutely lowers the risks of heart attacks, strokes, and other hypertension-related problems. It's just in the acute phase of a heart attack we have to be more careful of which agent to use and other agents have adde

        • Re: (Score:2)

          by PCM2 ( 4486 )

          No one has recommended beta blockers as a first line therapy for hypertension for decades.

          Well, somebody recommended them to me. At high doses, too.

    • Re: (Score:2)

      by MrBrklyn ( 4775 )

      (I am a cardiologist)

      This is an interesting thing, and needs to be followed closely.

      There are a group of medications that have been made the standard of care for the treatment of a heart attack. These medications were tested in numerous high quality trials (randomized, double blind, placebo-control). But many of the trials are old.

      So was the work of Galileo Galilei. That doesn't make it bad science.

      The fact is that we have made quantum improvements in MI survival rates in the last 20 years. People with MI's in their 40's routinely survive cardiovascular events which would had killed them in the 1990's. A study like this is interesting, but mostly bullshit. One study doesn't prove anything and retro studies are notoriously flawed.

      • cardiac patients are being treated differently than when the original trials were done.

        The time a ball takes to drop off the Leaning Tower in Pisa, not as much.

        • Except the conditions that the trials were done are different than now.

          Back in the 80s no one was getting a stent in the first 120 minutes of a heart attack (or the first 90 minutes of reaching a hospital). Now it's considered standard of care. This one change has rocked the world of cardiology and has reduced mortality from heart attack dramatically.

          Heart attack trials done before this have to be re-done in a more modern era.

          • Re: (Score:2)

            by MrBrklyn ( 4775 )

            Except the conditions that the trials were done are different than now.

            Back in the 80s no one was getting a stent in the first 120 minutes of a heart attack (or the first 90 minutes of reaching a hospital). Now it's considered standard of care. This one change has rocked the world of cardiology and has reduced mortality from heart attack dramatically.

            Heart attack trials done before this have to be re-done in a more modern era.

            I largely agree with this BUT even by the 1990s studies on statins in post-MI had been very encouraging and the use of Beta-Blockers have been broadly supported.

            THIS STUDY is pharmacy marketing 101 and a play right out of Coreg's marketing. It compares to a subset of overall patient populations and targets to to prove overall efficiency of a new drug based, falsely, on a subset of overall MI victims to be extrapolated in practice to the overall patient population. And they are attecking Bebta-Blockers whi

    • I am prescribed metoprolol even though my ejection volume was measured at 60% during the hospital stay, at 55% two years later when I reported an episode of chest pain.

      I was once taking an ACE inhibitor for blood pressure control 30 years prior and went to the ER when my upper lip puffed out making me look like a duck. They told me this was angioedema, but at the time, no one thought the ACE inhibitor was the cause. Since then, ACE inhibitors are said to be the leading cause of patients going to the ER

      • also feel like the moving truck I once rented that had a governor on the motor

        Wait, how fast were you going to find that out??

      • ACE Inhibitors and ARBs are not primarily prescribed to lower blood pressure, although that is a bonus because lower blood pressure does result in fewer cardiovascular incidents. ACE Inhibitors are principally prescribed in an attempt to reduce Cardiac remodelling. This theory is that where the muscle cells have died scar tissue forms, because your heart has to work harder to compensate for the reduction in blood flow greater stress is places on the scar tissue. This causes the heart to lose its usual hear

    • It has been known for a long time that beta blockers offer no benefit to patients with preserved ejection fraction. This is why the UK authority NICE does not recommend them for patients with preserved ejection fraction.

      These days in many cases patients no longer need an appointment for an echocardiogram to discover their ejection fraction, this can now be done on the ward, so beta blockers can be discontinued before discharge after an angioplasty.

      ACE Inhibitors or ARBs are routinely given to all MI patient

  • If you look past the superficial summary and read the study (or at least skimmed it), some of the useful conclusions were that rose essential oil (the scent used) it's possible people liked or disliked it and that caused the grey matter increase.

    the other thing to note was that only rose essential oil was tested, no other scents. so it's possible that other scents can do the same to stimulate the brain. with the understanding of the study, it's possible a hot new york restaurant dumpster in mid july m
    • what the heck, i responded to this post:

      https://science.slashdot.org/story/25/08/31/0621235/smelling-this-one-specific-scent-can-boost-the-brains-gray-matter

  • A ton of medications and procedure have been shown to reduce signs of medical problems but have not been shown to extend life expectancy or quality of life.

    Cholesterol medications are a prime example - they definitely reduce the bad cholesterol in your blood/raise the good stuff. But when I was younger at least, there were no studies showing increased life expectancy. For all we know they are reducing a symptom of the problem but not solving the problem itself.

    • The "word on the street" is that statins, medicines that lower bad cholesterol although I think it is hope over experience that they raise "good" (HDL) cholesterol, don't do much of anything for people who haven't had a heart attack. Once you have had a heart attack, their benefit to living longer is unmistakable.

      Someone point me to a source saying this is wrong.

    • Re: (Score:2)

      by MrBrklyn ( 4775 )

      A ton of medications and procedure have been shown to reduce signs of medical problems but have not been shown to extend life expectancy or quality of life.

      Cholesterol medications are a prime example - they definitely reduce the bad cholesterol in your blood/raise the good stuff. But when I was younger at least, there were no studies showing increased life expectancy. For all we know they are reducing a symptom of the problem but not solving the problem itself.

      That is just not true and furthermore, statins have been particularly useful in reach end points in post-MI patients... especially Rovastatin and Atrovastatin.

    • Raised LDL is not the only factor in heart disease, there is an inflammatory component to it as well. Some people have elevated LDL but very little stenosis, others have normal LDL but still suffer stenosis. What is known without doubt is that lowering LDL levels in MI patients is directly responsible for a significant reduction in repeat events. The results are different in the general population, simply because only those people that suffer from stenosis will see any improvement, statins do not stop peopl
  • SSRIs and School Shootings, FDA Corruption, and Why Everyone on Anti-Depressants Is Totally Unhappy [rumble.com]

    “Probably a fifth of the entire American population is on SSRIs. Psychiatrist Josef Witt-Doerring explains why that’s terrifying and dangerous.”
    --

    * About 15-20% of the U.S. population currently takes anti-depressants daily, a 500% increase since the early 1990s.

    * Despite heavy prescribing of SSRIs, overall mental health outcomes have worsened, with rising suicide and disability rat

  • The first study is for the new drug Vericiguat which costs thousands of dollars over beta-blockers. It is the incentive of Vericuguat producers to damage to reputation of Beta-Blockers for post-MI survival. At the end of the day, this study only addresses a small subset of patients and uses tha as FUD to suggest use of a drug that costs thousands of dollars over a cheap alternative... which has no corporate backers. You need to be very skeptical of this study. It might be evidence of efficiacy for Veri

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