MACE May Not Be Reduced With Beta Blocker Therapy in Stable CAD

Beta blocker therapy may not be beneficial in reducing major adverse cardiovascular events (MACE) in a population of patients with stable coronary artery disease, according to research results published in the American Journal of Cardiology.

In the current meta-analysis, researchers sought to determine the impact of beta blockers on MACE in patients with stable coronary artery disease—in particular, patients with no previous history of myocardial infarction or left ventricular dysfunction.

A total of 8797 articles were retrieved. After removing duplicates and applying the selection criteria, 79 articles remained, 73 of which were excluded. The final analysis included 6 observational studies and data from 774,089 patients with stable coronary artery disease and no previous history of either myocardial infarction or left ventricular dysfunction.

Mean participant age was 66±11 years; 64% were men. Studies were published between 2005 and 2017, and included an average follow-up period of 3 to 5.4 years. The included studies had a high quality score, with a mean of 8.67 points on the NOS quality assessment tool.

Results of the meta-analysis showed that beta blocker therapy did not reduce the risk of MACE, myocardial infarction, or cardiovascular death (CVD) (hazard ratios [HRs], 1.05, 1.13, and 0.95, respectively); no statistically significant effect was noted between beta blocker and control groups. Heterogeneity of these studies ranged from none to moderate.

In a meta-regression analysis, age, beta blocker prescription rate, and current smoking status were all predictors of MACE, while male gender and beta blocker prescription rate were both predictors of myocardial infarction. No predictor of CVD was identifier.

Results of sensitivity analyses indicated that the effects were statically nonsignificant between treatment and control groups on the omission of single studies in effect size calculations for MACE and CVD. The effect for myocardial infarction was significant when a 2016 study published my Motivala and colleauges was excluded.²

Study limitations include the review of only observational studies, a lack of access to the indications, types of beta blockers used, and dosing information limiting subgroup analysis, and low to moderate heterogeneity in the included studies.

“Our meta-analysis did not show the benefit of [beta blockers] in reducing the future occurrence of MACE,” the researchers concluded. “Thus, the routine administration of [beta blockers] in this setting may need to be cautiously reconsidered. To clarify the indications of [beta blockers] in this subset of population, randomized controlled trials are warranted to improve the quality of evidence.”

References

1. Arero AG, Vasheghani-Farahani A, Soltani D. Meta-analysis of the usefulness of beta-blockers to reduce the risk of major adverse cardiovascular events in patients with stable coronary artery disease without prior myocardial infarction or left ventricular dysfunction. Am J Cardiol. Published online August 27, 2021. doi:10.1016/j.amjcard.2021.08.005
2. Motivala AA, Parikh V, Roe M, et al. Predictors, trends, and outcomes (among older patients ≥65 years of age) associated with beta blocker use in patients with stable angina undergoing elective percutaneous coronary intervention: Insights from the NCDR Registry. JACC Cardiovasc Interv. 2016;9(16):1639-1648. doi:10.1016/j.jcin.2016.05.048