This common heart attack can be worthless for most people

A common treatment given after heart attacks may not be worth it for a large segment of the population. New trial data reveal that most people who suffer from a heart attack do not benefit from taking beta-blockers afterwards.

A large international team of researchers conducted the test, which compared the results of nearly 10,000 patients with heart attacks who had beta-blocan therapy or not.

On average, people with a preserved heart function given the beta-blockers were nonetheless likely to die or to undergo a second heart attack than those that were not beta, researchers revealed. Secondary data has also shown that women could in fact cope with a higher risk of complications in taking these drugs.

“This test will reshape all international clinical guidelines,” said the author of the main study, Valentin Fuster, president of Mount Sinai Fuster Heart Hospital, in a press release from Mount Sinai.

Why doctors use beta-blockers

For more than 40 years, beta-blockers have been a key aspect of treatment and management of cardiovascular disease. These drugs block the effects of adrenaline on beta receptors in the body, which then reduces heart rate and reduces blood pressure (among other body changes). They are often used to reduce stress on a seriously damaged heart after a heart attack (myocardial infarction), in theory, by reducing the risk of a second heart attack or other cardiovascular problems.

But heart medicine has evolved considerably since the arrival of the first beta-blockers in the 1960s. New treatments and improved knowledge allowed doctors to prevent these infarction from causing as much damage to the heart as before. And that has led some researchers to wonder if beta-blockers should always be considered as front line treatment after heart attacks, including the team behind this big new test.

Therapy that needs a restart

The team’s trial, named Reboot, involved around 8,500 people. The patients had all suffered relatively light heart attacks and seemed to have a left ventricular ejection fraction (LVEF) greater than 40%. Leve Measures to what extent our left ventricle (the main pumping chamber) pumps the blood. A healthy LVEF is generally considered greater than 51%, while the slightly reduced function is between 40%and 50%.

Half of the patients were randomized to receive beta-blockers after being released from the hospital, while the other half received none. The two groups were then followed for several years (median length 3.7 years).

At the end of the study, there was no significant difference in the results between the two groups. Deaths (of any cause), secondary heart attacks and hospital insufficiency have occurred just as often in the beta-blocker group as in the control group.

Given that these types of heart attacks represent the majority of cases (around 80%) today, the team’s results – issued during the weekend in the New England Journal of Medicine – indicate that beta -blockers should not be standard treatment for most patients of heart attack, according to researchers.

Harmful for some, useful for others

Although beta-blocker treatment can be worthless for most patients with male heart attack, it could be actively dangerous for women in particular.

In a secondary analysis of the results of the restart, published in the European Heart Journal, women on beta-blockers had higher rates of heart attacks, hospitalization and death that women who are not on the medication. By looking at it, this additional risk was only observed in women who have maintained a normal cardiac function (leve greater than 50%). Although it is not quite clear why only women could experience this risk, studies have shown that heart attacks can present themselves differently in women compared to men and cause different symptoms.

The results should better optimize the long -term care of patients with heart attack, which are often already prescribed by several drugs to keep their cardiovascular health in failure. “These results will help rationalize treatment, reduce side effects and improve the quality of life of thousands of patients each year,” said the main author Borja Ibáñez, scientific director of the National Center for Cardiovascular Research (CNIC), in a press release.

That said, the restart trial will not be built for good beta. Drugs can still help prevent complications in people with serious heart attacks and are widely used for other conditions, including congestive heart failure, migraines and even performance anxiety.