A Surprising Finding on Heart Attack Treatment
A prevalent medication prescribed post-heart attack may not be beneficial for many individuals, according to new trial results. Researchers from an extensive international team have concluded that beta-blockers, frequently administered after heart attacks, do not provide significant advantages for the majority of patients.
The large-scale trial examined nearly 10,000 patients who had experienced heart attacks, comparing outcomes between those who received beta-blocker therapy and those who did not.
“This trial will reshape all international clinical guidelines,”
stated Valentin Fuster, senior author of the study and president of Mount Sinai Fuster Heart Hospital.
Understanding Beta-Blockers
For over four decades, beta-blockers have been integral in the treatment and management of cardiovascular conditions. By blocking adrenaline’s effects on the body’s beta-receptors, these drugs lower heart rate and blood pressure. Traditionally, they are used to alleviate strain on a damaged heart post-myocardial infarction, with the intention of minimizing the risk of subsequent cardiovascular incidents.
However, advancements in heart medicine since the 1960s have led researchers to reevaluate the necessity of beta-blockers as a first-line treatment following heart attacks.
The REBOOT Trial
The REBOOT trial involved approximately 8,500 participants who experienced relatively mild heart attacks with a left ventricular ejection fraction (LVEF) above 40%. LVEF indicates how efficiently the left ventricle pumps blood, with normal ranges typically above 51%.
Participants were randomly assigned to receive beta-blockers post-discharge or to a control group with no medication. They were monitored over an average period of 3.7 years.
Ultimately, the trial revealed no significant differences in outcomes between the two groups. Instances of death, recurrent heart attacks, and hospitalizations for heart failure occurred at similar rates in both cohorts.
Given that this type of heart attack comprises about 80% of cases today, the researchers argue that beta-blockers should not be a standard treatment for most heart attack patients. The findings were published in the New England Journal of Medicine.
Specific Risks for Women
While beta-blockers may prove ineffective for many male heart attack survivors, they could pose additional risks for women. A secondary analysis of the REBOOT data published in the European Heart Journal highlighted that women on beta-blockers exhibited higher rates of heart attacks, hospitalizations, and mortality compared to their counterparts not taking the medication.
This increased risk was observed primarily in women with normal heart function (LVEF above 50%). The reasons for this discrepancy remain unclear, though prior studies suggest that heart attack presentations and symptoms can vary between women and men.
Fuster believes the findings will enhance the long-term care of heart attack patients, who often rely on multiple medications for cardiovascular health management. Borja Ibáñez, the lead author and scientific director at Spain’s National Center for Cardiovascular Research (CNIC), remarked:
“These results will help streamline treatment, reduce side effects, and improve quality of life for thousands of patients every year.”
The Future of Beta-Blockers
Despite the implications of the REBOOT trial, beta-blockers are unlikely to become obsolete. They may still play a role in preventing complications for individuals suffering from severe heart attacks and continue to be prescribed for other conditions, including congestive heart failure, migraines, and performance anxiety.
