People who take drugs called beta-blockers aren't always helped by them, a study has found. The study included more than 20,000 adults. All had either stable heart disease or just risk factors for heart disease. Beta-blockers did not appear to help any of the groups. In people with risk factors only, beta-blocker treatment slightly increased the risks for heart attack, stroke and death from heart disease. The authors of the study call for randomized clinical trials to help define which patients would benefit from taking beta-blockers. The study was published October 2 in the online version of the Journal of the American Medical Association. Science News, HealthDay News and other media wrote about it.

By Reena Pande, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

Heart disease remains the top cause of death in adults in the United States. Over the last several decades, doctors have focused on lowering the number of heart attacks and reducing complications after heart attacks. This can be done with medications and with changes in lifestyle. If you have a heart attack, you are often sent home with several new medications. They are given to lower your chances of new or worsening heart problems.

A study published in the Journal of the American Medical Association raises questions about one class of these medications, called beta-blockers. They often are used in patients with heart disease. Beta-blockers have many good effects. They decrease heart rate, decrease blood pressure and reduce strain on the heart. But they also can have side effects. These include tiredness, low blood pressure, a slowed heart rate, feeling lightheaded and sexual problems. This study followed more than 44,000 stable patients in three groups:

• People with known heart blockages (coronary artery disease, also known as CAD) and a history of having a heart attack
• People with known heart blockages but no history of heart attack
• People with risk factors for developing heart blockages but no known CAD or history of heart attack

In each of these groups, the researchers compared people taking beta-blockers to those who were not. They looked at rates of heart attacks, strokes and death from heart disease.

Rates were no different in the first two groups (those with stable heart blockages). In the group with risk factors but no proven heart disease, people taking beta-blockers did a little worse.

While the findings are valid, the study should be taken with a grain of salt. Although no benefit was shown for beta-blockers in stable patients, we know that beta-blockers are really good for other kinds of patients. These include people with:

• A recent heart attack
• Stable congestive heart failure
• Palpitations and other heart rhythm problems
• High blood pressure
• Migraine headaches

There are still plenty of situations in which I will prescribe beta-blockers. But the study serves as a reminder that just because something works for certain groups of people, it may not work for everyone.

What changes can I make now?

There are many ways to prevent a future heart attack, even if you have already had one. Here are some ways you can reduce your risk:

Lifestyle changes

• Stop smoking.
• Eat a healthy and well-balanced diet.
• Get regular exercise. That means 75 minutes per week of vigorous activity or 150 minutes per week of more moderate activity.
• Work on losing weight if you are overweight or obese.
• Manage your stress.

Medications

• Anti-platelet medications – Aspirin, clopidogrel (Plavix), ticagrelor (Brilinta) and prasugrel (Effient) may be used in patients with stents or in those at high risk of complications after a heart attack.



• Statins - These medications lower cholesterol, but they also have many other benefits. They reduce the risks of heart attacks, stroke and death.



• ACE Inhibitors – These medications are typically used to lower blood pressure, but in certain cases can help reduce the risk of worsening heart function.

Your doctor will be able to help you figure out which medications are right for you.

What can I expect looking to the future?

You should expect to hear more about ongoing efforts to find ways to lower the risk of heart attacks. This may be with medications, devices or lifestyle interventions. We have made huge strides in improving the care for patients with heart disease. However, we still have a long way to go and a lot to learn.

Remember, no one therapy is right for all people. Studies like these remind us that it’s important to review your situation with your doctor to figure out which treatments are right for you.