Key result
Lipophilic beta-blockers reduced all-cause mortality by 53% compared to hydrophilic beta-blockers (HR 0.467) in Japanese patients with coronary artery disease.
Why the study?
Does beta-blocker prescription at discharge reduce mortality and cardiovascular events in Japanese patients with coronary artery disease?
Cohort (n=13,812)
Yes
Does beta-blocker prescription at discharge reduce mortality and cardiovascular events in Japanese patients with coronary artery disease?
In Japanese patients with coronary artery disease, routine beta-blocker prescription at discharge did not significantly reduce composite cardiovascular events, though lipophilic beta-blockers were associated with lower all-cause mortality than hydrophilic ones.
Answers are grounded in this paper and cite their sources.
May support preferring lipophilic over hydrophilic beta-blockers in CAD; leaves open need for randomized confirmation.
BACKGROUND: Beta-blockers are underprescribed for coronary artery disease (CAD) patients in Japan. Considering the vast amount of evidence showing their benefits in this group of patients, the aim of the present study was to investigate the use of beta-blockers in a large cohort of CAD patients. METHODS AND RESULTS: The 13,812 patients with angiographically confirmed CAD were followed up for 2.7 years. From this group, 4,160 (30.1%) patients were prescribed beta-blockers at the time of discharge. These patients were significantly more likely to have hypertension, hyperlipidemia, obesity, a family history of ischemic diseases and a higher number of diseased arteries. The rate of continuation for beta-blockers was 90.8%. A propensity score matching analysis showed no additional benefits of beta-blockers in reducing all-cause mortality, cardiac events and cerebrovascular events. Lipophilic beta-blockers were significantly more effective than hydrophilic ones in reducing all-cause mortality (hazard ratio 0.467, 95% confidence interval 0.247-0.880, P=0.019). CONCLUSIONS: Despite the low prescription rate of beta-blockers for CAD patients among Japanese physicians, the continuation rate was relatively high. Lipophilic beta-blockers may be a better choice than hydrophilic beta-blockers in terms of mortality risk, although a randomized control study would need to be conducted to verify this assertion.
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Kohro et al. (2010) conducted a cohort in Coronary artery disease (n=13,812). Lipophilic beta-blockers vs. Hydrophilic beta-blockers was evaluated on All-cause mortality (HR 0.467, 95% CI 0.247-0.880, p=0.019). Lipophilic beta-blockers reduced all-cause mortality by 53% compared to hydrophilic beta-blockers (HR 0.467) in Japanese patients with coronary artery disease.
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