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Effectiveness of beta blockers in patients with and without a history of myocardial infarction.

Abstract：

PURPOSE:Studies demonstrating mortality benefit of beta blockers (BB) after myocardial infarction (MI) were conducted before the era of percutaneous intervention and widespread use of statins. Recent retrospective studies show inconsistent results regarding which subgroups of coronary artery disease (CAD) patients' benefit. Most studies did not account for medication changes over time. We evaluated the association of time-varying BB exposure with death in CAD patients with or without a history of MI. METHODS:This retrospective cohort study included all patients with MI and those with coronary disease but no MI at a single health care system who also had health insurance from January 1, 1997, to June 30, 2011. Pharmacy claims data were used to estimate BB exposure over 6-month rolling windows. The primary endpoint was all-cause death. The effect of BB exposure was tested using time-updated Cox proportional hazards models. RESULTS:We identified 6220 patients with MI and 21,285 patients with CAD but no MI. Among patients who suffered MI, BB exposure was associated with a 31% relative risk reduction in all-cause death (hazard ratio [HR] 0.69, P = 0.001). Among subjects who survived 3 years after MI, BB retained a protective association (HR 0.71, P = 0.001). Among CAD-only patients, BB exposure was also associated with risk reduction (HR 0.85, P = 0.001). CONCLUSION:Among patients with CAD, BB exposure is associated with reduced risk of death. The association is strongest among those who have suffered MI. This favorable association appears durable beyond 3 years.

journal_name

Eur J Clin Pharmacol

journal_title

European journal of clinical pharmacology

authors

Verma S,Peterson EL,Liu B,Sabbah HN,Williams LK,Lanfear DE

doi

10.1007/s00228-020-02886-0

subject

Has Abstract

pub_date

2020-08-01 00:00:00

pages

1161-1168

issue

8

eissn

0031-6970

issn

1432-1041

pii

10.1007/s00228-020-02886-0

journal_volume

76

pub_type

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