Do beta-blockers benefit patients with T2D and ASCVD?

  • Shavadia JS & al.
  • Am Heart J
  • 20.10.2019

  • von Miriam Tucker
  • Clinical Essentials
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Takeaway

  • No decrease in major cardiovascular (CV) event risk found for β-blocker use in patients with type 2 diabetes (T2D) and atherosclerotic CV disease (ASCVD).

Why this matters

  • In era of newer glucose-lowering therapies with independent CV risk reduction, β-blocker role in T2D is uncertain.

Study design

  • Analysis from 14,671 patients with T2D and ASCVD in Trial Evaluating Cardiovascular Outcomes with Sitagliptin, including 9322 on baseline β-blockers.  
  • Funding: Merck & Co., Inc., Kenilworth, NJ, USA.

Key results

  • During median 3.0 years, unadjusted composite risk for CV death, nonfatal myocardial infarction (MI), nonfatal stroke, and unstable angina hospitalization was significantly higher with baseline β-blocker therapy vs no β-blockers (4.5 vs 3.4 events/100 patient-years; P<.001>
  • After selection bias adjustment: adjusted HR, 1.17 (P=.003).
  • Unadjusted event rates and inverse probability weighted-adjusted risk (adjusted HRs; 95% CIs) for β-blocker use vs nonuse:
    • With prior MI:
      • 5.1 vs 4.6 events/100 patient-years;
      • 1.10 (0.95-1.27). 
    • No prior MI:
      • 3.9 vs 3.0 events/100 patient-years;
      • 1.20 (1.04-1.37; P-interaction=.42).
    • With prior heart failure (HF):
      • 6.4 vs 6.2 events/100 patient-years;
      • 1.13 (0.94-1.37).
    • No prior HF:
      • 0.74 vs 0.72 events/100 patient-years;
      • 1.22 (1.09-1.38; P-interaction=.50).
  • Limitations

    • No information on changes in β-blocker use, β-blocker type, ejection fraction, timing since last MI.  
    • Generalizability possibly limited.