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