| β-Blocker use and clinical outcomes in stable outpatients with and without coronary artery disease. | |
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MedLine Citation:
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PMID: 23032550 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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CONTEXT: β-Blockers remain the standard of care after a myocardial infarction (MI). However, the benefit of β-blocker use in patients with coronary artery disease (CAD) but no history of MI, those with a remote history of MI, and those with only risk factors for CAD is unclear. OBJECTIVE: To assess the association of β-blocker use with cardiovascular events in stable patients with a prior history of MI, in those with CAD but no history of MI, and in those with only risk factors for CAD. DESIGN, SETTING, AND PATIENTS: Longitudinal, observational study of patients in the Reduction of Atherothrombosis for Continued Health (REACH) registry who were divided into 3 cohorts: known prior MI (n = 14,043), known CAD without MI (n = 12,012), or those with CAD risk factors only (n = 18,653). Propensity score matching was used for the primary analyses. The last follow-up data collection was April 2009. MAIN OUTCOME MEASURES: The primary outcome was a composite of cardiovascular death, nonfatal MI, or nonfatal stroke. The secondary outcome was the primary outcome plus hospitalization for atherothrombotic events or a revascularization procedure. RESULTS: Among the 44,708 patients, 21,860 were included in the propensity score-matched analysis. With a median follow-up of 44 months (interquartile range, 35-45 months), event rates were not significantly different in patients with β-blocker use compared with those without β-blocker use for any of the outcomes tested, even in the prior MI cohort (489 [16.93%] vs 532 [18.60%], respectively; hazard ratio [HR], 0.90 [95% CI, 0.79-1.03]; P = .14). In the CAD without MI cohort, the associated event rates were not significantly different in those with β-blocker use for the primary outcome (391 [12.94%]) vs without β-blocker use (405 [13.55%]) (HR, 0.92 [95% CI, 0.79-1.08]; P = .31), with higher rates for the secondary outcome (1101 [30.59%] vs 1002 [27.84%]; odds ratio [OR], 1.14 [95% CI, 1.03-1.27]; P = .01) and for the tertiary outcome of hospitalization (870 [24.17%] vs 773 [21.48%]; OR, 1.17 [95% CI, 1.04-1.30]; P = .01). In the cohort with CAD risk factors only, the event rates were higher for the primary outcome with β-blocker use (467 [14.22%]) vs without β-blocker use (403 [12.11%]) (HR, 1.18 [95% CI, 1.02-1.36]; P = .02), for the secondary outcome (870 [22.01%] vs 797 [20.17%]; OR, 1.12 [95% CI, 1.00-1.24]; P = .04) but not for the tertiary outcomes of MI (89 [2.82%] vs 68 [2.00%]; HR, 1.36 [95% CI, 0.97-1.90]; P = .08) and stroke (210 [6.55%] vs 168 [5.12%]; HR, 1.22 [95% CI, 0.99-1.52]; P = .06). However, in those with recent MI (≤1 year), β-blocker use was associated with a lower incidence of the secondary outcome (OR, 0.77 [95% CI, 0.64-0.92]). CONCLUSION: In this observational study of patients with either CAD risk factors only, known prior MI, or known CAD without MI, the use of β-blockers was not associated with a lower risk of composite cardiovascular events. |
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Authors:
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Sripal Bangalore; Gabriel Steg; Prakash Deedwania; Kevin Crowley; Kim A Eagle; Shinya Goto; E Magnus Ohman; Christopher P Cannon; Sidney C Smith; Uwe Zeymer; Elaine B Hoffman; Franz H Messerli; Deepak L Bhatt; |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: JAMA : the journal of the American Medical Association Volume: 308 ISSN: 1538-3598 ISO Abbreviation: JAMA Publication Date: 2012 Oct |
Date Detail:
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Created Date: 2012-10-03 Completed Date: 2012-10-09 Revised Date: 2013-04-16 |
Medline Journal Info:
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Nlm Unique ID: 7501160 Medline TA: JAMA Country: United States |
Other Details:
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Languages: eng Pagination: 1340-9 Citation Subset: AIM; IM |
Affiliation:
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Cardiovascular Clinical Research Center, New York University School of Medicine, 550 First Ave, New York, NY 10016, USA. sripalbangalore@gmail.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic beta-Antagonists
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therapeutic use* Aged Cardiovascular Diseases / mortality*, prevention & control Coronary Artery Disease / drug therapy*, mortality* Female Hospitalization / statistics & numerical data Humans Incidence Longitudinal Studies Male Middle Aged Myocardial Infarction / drug therapy* Myocardial Revascularization / statistics & numerical data Propensity Score Risk Factors Stroke / epidemiology |
| Chemical | |
Reg. No./Substance:
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0/Adrenergic beta-Antagonists |
| Comments/Corrections | |
Comment In:
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Expert Rev Cardiovasc Ther. 2013 Mar;11(3):289-91
[PMID:
23469908
]
JAMA. 2013 Feb 6;309(5):439-40 [PMID: 23385261 ] JAMA. 2013 Feb 6;309(5):438-9 [PMID: 23385259 ] JAMA. 2013 Feb 6;309(5):438 [PMID: 23385258 ] JAMA. 2013 Feb 6;309(5):439 [PMID: 23385260 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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