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Dar JA, Jacob JR. Beta Blockers in Contemporary Cardiology: Is It Better to Cast Them Out? Korean Circ J 2024; 54:165-171. [PMID: 38654562 PMCID: PMC11040266 DOI: 10.4070/kcj.2023.0209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 01/25/2024] [Accepted: 02/13/2024] [Indexed: 04/26/2024] Open
Abstract
Beta blockers are one of the commonest prescription drugs in medicine and they have been thought to revolutionize the treatment of heart failure (HF) with reduced ejection fraction (HFrEF) in the last century. In addition to HFrEF, they are prescribed for a variety of diseases in cardiology from hypertension to HF, angina, and stable coronary artery disease (CAD). The increased prescription of beta blockers in conditions like HF with preserved ejection fraction (HFpEF), and stable CAD may be doing more harm than good as per the data we have so far. The available data shows that beta blockers are associated with increased stroke risk and atrial fibrillation (AF) in hypertension and in patients with HFpEF, they have been associated with decreased exercise capacity. In patients with stable CAD and patients with myocardial infarction with normal systolic functions, beta blockers don't offer any mortality benefit. In this article, we critically review the common indications and the uses of beta blockers in patients with HFpEF, CAD, hypertension and AF and we propose that beta blockers are over-prescribed under the shadow of their beneficial effects in patients with HFrEF.
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Affiliation(s)
- Javaid Ahmad Dar
- Department of Cardiology, Christian Medical College, Vellore, India.
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Godoy LC, Farkouh ME, Austin PC, Shah BR, Qiu F, Jackevicius CA, Wijeysundera HC, Krumholz HM, Ko DT. Association of Beta-Blocker Therapy With Cardiovascular Outcomes in Patients With Stable Ischemic Heart Disease. J Am Coll Cardiol 2023; 81:2299-2311. [PMID: 37316110 DOI: 10.1016/j.jacc.2023.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Previous studies have failed to show a cardioprotective benefit of beta-blockers in patients with stable coronary artery disease (CAD). OBJECTIVES This study sought to determine the association between beta-blockers and cardiovascular events in patients with stable CAD using a new user design. METHODS All patients aged >66 years undergoing elective coronary angiography in Ontario, Canada, from 2009 to 2019 with diagnosed obstructive CAD were included. Exclusion criteria included heart failure or a recent myocardial infarction, as well as having a beta-blocker prescription claim in the previous year. Beta-blocker use was defined as having at least 1 beta-blocker prescription claim in the 90 days preceding or after the index coronary angiography. The main outcome was a composite of all-cause mortality and hospitalization for heart failure or myocardial infarction. Inverse probability of treatment weighting using the propensity score was used to account for confounding. RESULTS This study included 28,039 patients (mean age: 73.0 ± 5.6 years; 66.2% male), and 12,695 of those (45.3%) were newly prescribed beta-blockers. The 5-year risks of the primary outcome were 14.3% in the beta-blocker group and 16.1% in the no beta-blocker group (absolute risk reduction: -1.8%; 95% CI: -2.8 to -0.8; HR: 0.92; 95% CI: 0.86-0.98; P = 0.006). This result was driven by reductions in myocardial infarction hospitalization (cause-specific HR: 0.87; 95% CI: 0.77-0.99; P = 0.031), whereas no differences were observed in all-cause death or heart failure hospitalization. CONCLUSIONS In patients with angiographically documented stable CAD without heart failure or a recent myocardial infarction, beta-blockers were associated with a small but significant reduction in cardiovascular events at 5 years.
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Affiliation(s)
- Lucas C Godoy
- Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Institute of Health Policy Management, and Evaluation, University of Toronto, Ontario, Canada; Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Michael E Farkouh
- Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada; Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Peter C Austin
- ICES, Toronto, Ontario, Canada; Institute of Health Policy Management, and Evaluation, University of Toronto, Ontario, Canada
| | - Baiju R Shah
- ICES, Toronto, Ontario, Canada; Institute of Health Policy Management, and Evaluation, University of Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Cynthia A Jackevicius
- ICES, Toronto, Ontario, Canada; Institute of Health Policy Management, and Evaluation, University of Toronto, Ontario, Canada; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA; Western University of Health Services, Pomona, California, USA
| | - Harindra C Wijeysundera
- ICES, Toronto, Ontario, Canada; Institute of Health Policy Management, and Evaluation, University of Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
| | - Dennis T Ko
- ICES, Toronto, Ontario, Canada; Institute of Health Policy Management, and Evaluation, University of Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Lee SJ, Choi DW, Kim C, Suh Y, Hong SJ, Ahn CM, Kim JS, Kim BK, Ko YG, Choi D, Park EC, Jang Y, Nam CM, Hong MK. Long-Term Beta-Blocker Therapy in Patients With Stable Coronary Artery Disease After Percutaneous Coronary Intervention. Front Cardiovasc Med 2022; 9:878003. [PMID: 35656394 PMCID: PMC9152083 DOI: 10.3389/fcvm.2022.878003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/15/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundIt is unclear whether beta-blocker treatment is advantageous in patients with stable coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI). We evaluated the clinical impact of long-term beta-blocker maintenance in patients with stable CAD after PCI with drug-eluting stent (DES).MethodsFrom a nationwide cohort database, we identified the stable CAD patients without current or prior history of myocardial infarction or heart failure who underwent DES implantation. An intention-to-treat principle was used to analyze the impact of beta-blocker treatment on long-term outcomes of major adverse cardiovascular events (MACE) composed of cardiovascular death, myocardial infarction, and hospitalization with heart failure.ResultsAfter stabilized inverse probability of treatment weighting, a total of 78,380 patients with stable CAD was enrolled; 45,746 patients with and 32,634 without beta-blocker treatment. At 5 years after PCI with a 6-month quarantine period, the adjusted incidence of MACE was significantly higher in patients treated with beta-blockers [10.0 vs. 9.1%; hazard ratio (HR) 1.11, 95% CI 1.06–1.16, p < 0.001] in an intention-to-treat analysis. There was no significant difference in all-cause death between patients treated with and without beta-blockers (8.1 vs. 8.2%; HR 0.99, 95% CI 0.94–1.04, p = 0.62). Statistical analysis with a time-varying Cox regression and rank-preserving structure failure time model revealed similar results to the intention-to-treat analysis.ConclusionsAmong patients with stable CAD undergoing DES implantation, long-term maintenance with beta-blocker treatment might not be associated with clinical outcome improvement.Trial RegistrationClinicalTrial.gov (NCT04715594).
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Affiliation(s)
- Seung-Jun Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong-Woo Choi
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
- Cancer Big Data Center, National Cancer Control Institute, National Cancer Center, Goyang, South Korea
| | - Choongki Kim
- Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Yongsung Suh
- Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea
| | - Sung-Jin Hong
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chul-Min Ahn
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jung-Sun Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Byeong-Keuk Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Young-Guk Ko
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Donghoon Choi
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun-Cheol Park
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Yangsoo Jang
- CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, South Korea
| | - Chung-Mo Nam
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
- Chung-Mo Nam
| | - Myeong-Ki Hong
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
- *Correspondence: Myeong-Ki Hong
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Roh JW, Kim Y. Role of β-Blockers in Chronic Coronary Artery Disease Management in the Percutaneous Coronary Intervention Era: Good Symptom Control or Something More? Korean Circ J 2022; 52:556-557. [PMID: 35656934 PMCID: PMC9257154 DOI: 10.4070/kcj.2022.0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/26/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ji Woong Roh
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Korea
| | - Yongcheol Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Korea
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Fukase T, Dohi T, Koike T, Yasuda H, Takeuchi M, Takahashi N, Chikata Y, Endo H, Doi S, Nishiyama H, Okai I, Iwata H, Okazaki S, Miyauchi K, Daida H, Minamino T. Long-term impact of β-blocker in elderly patients without myocardial infarction after percutaneous coronary intervention. ESC Heart Fail 2021; 9:545-554. [PMID: 34811932 PMCID: PMC8787957 DOI: 10.1002/ehf2.13715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/24/2021] [Accepted: 10/31/2021] [Indexed: 11/09/2022] Open
Abstract
AIMS Little is known about the long-term outcomes of β-blockers use in patients with coronary artery disease (CAD) without myocardial infarction (MI) and reduced ejection fraction (rEF). However, more attention should be paid to the oral administration of β-blockers in elderly patients who are susceptible to heart failure (HF), sinus node dysfunction, or rate response insufficiency. We aimed to evaluate the long-term impact of β-blockers in elderly patients with CAD without MI or systolic HF who have undergone percutaneous coronary intervention. METHODS AND RESULTS A total of 1018 consecutive elderly patients with CAD (mean age, 72 ± 7 years; 77% men) who underwent their first intervention between 2010 and 2018 were included in this study. According to the presence or absence of the use of β-blockers, 514 patients (50.5%) were allocated to the β-blocker group, and 504 (49.5%) to the non-β-blocker group. We evaluated the incidence of 4-point major adverse cardiovascular events (4P-MACE), including cardiovascular death, non-fatal MI, non-fatal stroke, admission for HF, target vessel revascularization (TVR), and all-cause death. We focused on the association between chronotropic incompetence of β-blockers and incidence of a new HF and analysed the results using an exercise electrocardiogram regularly performed in the outpatient department after percutaneous coronary intervention. During a median follow-up duration of 5.1 years, 83 patients (8.3%) developed 4P-MACE, including cardiovascular death in 17, non-fatal MI in 13, non-fatal stroke in 25, and admission for HF in 39 patients. Additionally, 124 patients (12.2%) had a TVR and 104 (10.2%) died of other causes. Kaplan-Meier analysis showed that the cumulative incidence rate of 4P-MACE in the β-blocker group was significantly higher than that in the non-β-blocker group (15.4% vs. 10.0%, log-rank test, P = 0.015). Above all, the cumulative incidence rate of admission for HF in the β-blocker group was significantly higher (8.8% vs. 3.2%, log-rank test, P < 0.001). The β-blocker group had significantly lower resting heart rate, stress heart rate, and stress-rest Δ heart rate on exercise electrocardiogram. Multivariate Cox hazard analysis revealed that EF, β-blocker use, stress-rest Δ heart rate, and CKD were strong independent predictors of admission for HF. CONCLUSIONS Long-term β-blocker use was significantly associated with an increased risk of adverse cardiovascular events in elderly patients with CAD without MI or systolic HF. In particular, the chronotropic incompetence action of β-blockers could increase the risk of admission for HF in elderly patients with CAD without MI and systolic HF, and the present findings warrant further investigation.
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Affiliation(s)
- Tatsuya Fukase
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Takuma Koike
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hidetoshi Yasuda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Mitsuhiro Takeuchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Norihito Takahashi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yuichi Chikata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hirohisa Endo
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Shinichiro Doi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hiroki Nishiyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Iwao Okai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hiroshi Iwata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Katsumi Miyauchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, Tokyo, Japan
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Arero AG, Vasheghani-Farahani A, Soltani D. Meta-Analysis of the Usefulness of Beta-Blockers to Reduce the Risk of Major Adverse Cardiovascular Events in Patients With Stable Coronary Artery Disease Without Prior Myocardial Infarction or Left Ventricular Dysfunction. Am J Cardiol 2021; 158:23-29. [PMID: 34462051 DOI: 10.1016/j.amjcard.2021.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/17/2021] [Accepted: 08/03/2021] [Indexed: 12/01/2022]
Abstract
Beta-blockers (BBs) are the core of coronary artery disease (CAD) pharmacotherapy and demonstrated a well-established benefit in the treatment of acute myocardial infarction (MI). However, the prophylactic role of BBs to affect adverse outcomes in patients with stable CAD, especially among those without a pervious history of MI or left ventricular dysfunction, is not yet addressed. We aimed to determine the effects of beta-blockers on major adverse cardiovascular events (MACE) in patients with stable CAD without prior MI or left ventricular dysfunction. We searched PubMed, EMBASE, Web of Science, Scopus, Google Scholar, and Cochrane Controlled Trials Register for studies published from inception to March 31, 2021. Two researchers independently reviewed the database searches and selected eligible studies. A third reviewer was consulted whenever necessary. A total of 6 studies were included in the final analysis. BBs therapy did not reduce the risk of a MACE (HR, 1.05; 95% CI, 0.91 to 1.20), MI (HR, 1.13; 95% CI, 0.95 to 1.34), and cardiovascular death (HR, 0.95; 95% CI, 0.79 to 1.14). No statistically significant effect was observed between the participants on beta-blocker and control groups. In conclusion, our meta-analysis did not show the benefit of BBs in reducing MACE among patients with stable CAD without previous history of MI or left ventricular dysfunction.
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Affiliation(s)
- Amanuel Godana Arero
- Cardiac Primary Prevention Research Center (CPPRC), Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran; Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Ali Vasheghani-Farahani
- Cardiac Primary Prevention Research Center (CPPRC), Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Clinical Cardiac Electrophysiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Danesh Soltani
- Cardiac Primary Prevention Research Center (CPPRC), Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran; Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
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Gu J, Yin ZF, Xu ZJ, Fan YQ, Wang CQ, Zhang JF. Incident Heart Failure in Patients With Coronary Artery Disease Undergoing Percutaneous Coronary Intervention. Front Cardiovasc Med 2021; 8:727727. [PMID: 34671653 PMCID: PMC8520925 DOI: 10.3389/fcvm.2021.727727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 08/30/2021] [Indexed: 02/06/2023] Open
Abstract
Background: The contemporary incidence of heart failure (HF) in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) remains unclear. This prospective cohort study was designed to study the incidence and predictors of new-onset HF in CAD patients after PCI (ChiCTR1900023033). Methods: From January 2014 to December 2018, 3,910 CAD patients without HF history undergoing PCI were prospectively enrolled. Demographics, medical history, cardiovascular risk factors, cardiac parameters, and medication data were collected at baseline. Multivariable adjusted competing-risk regression analysis was performed to examine the predictors of incident HF. Results: After a median follow-up of 63 months, 497 patients (12.7%) reached the primary endpoint of new-onset HF, of which 179, 110, and 208 patients (36.0, 22.1, and 41.9%) were diagnosed as having HF with reduced ejection fraction (EF) (HFrEF), HF with mid-range EF (HFmrEF), and HF with preserved EF (HFpEF), respectively. Higher B-type natriuretic peptide (BNP) or E/e' level, lower estimated glomerular filtration rate (eGFR) level, and atrial fibrillation were the independent risk factors of new-onset HF. Gender (male) and angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (ACEI/ARB) prescription were the negative predictors of new-onset HF. Moreover, it was indicated that long-term ACEI/ARB therapy, instead of beta-blocker use, was linked to lower risks of development of all three HF subtypes (HFrEF, HFmrEF and HFpEF). Conclusions: This prospective longitudinal cohort study shows that the predominant subtype of HF after PCI is HFpEF and ACEI/ARB therapy is accompanied with reduced risks of incident HF across three subtypes.
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Affiliation(s)
- Jun Gu
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhao-Fang Yin
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zuo-Jun Xu
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yu-Qi Fan
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chang-Qian Wang
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jun-Feng Zhang
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Association of β-Blocker Therapy at Discharge with Clinical Outcomes after Acute Coronary Syndrome in Patients without Heart Failure. Cardiovasc Ther 2020; 2020:4351469. [PMID: 32405323 PMCID: PMC7196986 DOI: 10.1155/2020/4351469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 03/26/2020] [Accepted: 04/06/2020] [Indexed: 11/18/2022] Open
Abstract
Aim To evaluate the clinical impact of β-blocker in patients with adequate left ventricular ejection function (LVEF) who underwent percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). Methods A total of 10,724 consecutive patients who underwent PCI throughout 2013 were prospectively enrolled in the study. Among these, we analyzed 5,631 ACS patients who were discharged with LVEF ≥ 40%. Patients were then compared according to the β-blocker prescription at discharge. Results During a 2-year follow-up, no significant association was observed of β-blocker use with all-cause mortality (with β-blockers 47/5,043 (0.9%) vs. without β-blocker use 8/588 (1.4%); hazard ratio (HR) 0.762, 95% confidence interval 0.36 to 1.64; P = 0.485), cardiac death, myocardial infarction (MI), or major adverse cardiovascular and cerebrovascular events. Subgroup analysis demonstrated that the β-blocker use at discharge reduced the 2-year mortality in patients with unstable angina (UA) (HR 0.42, 95% CI 0.19 to 0.94, P = 0.034). Landmark analysis at 1 year showed that patients with UA who were discharged with β-blockers had lower mortality (HR 0.17, 95% CI 0.04-0.65, P = 0.010) and cardiac death (HR 0.12, 95% CI 0.01-0.99, P = 0.049) than those discharged without β-blockers. However, the benefit was lost beyond 1 year. No differences in outcomes were recorded in the AMI or overall population. Conclusions We present that β-blocker significantly lowers the rate of all-cause death up to 1 year, in UA patients who have undergone PCI and have adequate LVEF. Its role in patients with AMI also deserves further exploration.
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Andreasen C, Andersson C. Current use of beta-blockers in patients with coronary artery disease. Trends Cardiovasc Med 2018; 28:382-389. [PMID: 29373178 DOI: 10.1016/j.tcm.2017.12.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 12/13/2017] [Accepted: 12/29/2017] [Indexed: 12/13/2022]
Abstract
Beta-blockers have long comprised a cornerstone in the symptomatic treatment of ischemic heart disease and in the secondary prevention of myocardial infarction and heart failure. The majority of studies underlying the evidence of a beneficial effect of beta-blockers on outcomes were conducted more than 25 years ago. In a contemporary era where treatment strategies and secondary prophylactic therapy have undergone several changes, the continued role of beta-blockers in ischemic heart disease has been questioned, especially in the absence of heart failure or a recent myocardial infarction. In summary, few randomized clinical trials are available on the effect of beta-blockers in the reperfusion era, especially on hard endpoints. Likewise, the results of numerous observational studies and meta-analysis are conflicting, emphasizing the need for additional large-scale randomized clinical trials to evaluate the role of beta-blocker therapy in current clinical practice.
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Nikolic VN, Jankovic SM, Deljanin-Ilic M, Stojanovic SS, Nikolic ML, Zivanovic S, Stokanovic D, Jevtovic-Stoimenov T, Milovanovic JR. Population Pharmacokinetic Analysis of Bisoprolol in Patients with Stable Coronary Artery Disease. Eur J Drug Metab Pharmacokinet 2017; 43:35-44. [DOI: 10.1007/s13318-017-0414-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Reply: Effect of Pre-Procedural β-Blocker in Patients Undergoing Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2016; 9:2459-2460. [PMID: 27931599 DOI: 10.1016/j.jcin.2016.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 10/17/2016] [Indexed: 10/20/2022]
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Jaradat M, Shetty K, Hasan M, Malik AO, Shawo A, Ahsan C, Yoo JW. Beta-blockers do not provide survival benefit in a population with angiographic coronary artery disease without myocardial infarction or reduced ejection fraction: A meta-analysis. Int J Cardiol 2016; 223:976-980. [DOI: 10.1016/j.ijcard.2016.08.239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 07/11/2016] [Accepted: 08/12/2016] [Indexed: 11/28/2022]
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Nappi AG, Boden WE. Should Beta-Blockers Continue to Be Used in Post-Percutaneous Coronary Intervention Patients Without Myocardial Infarction? JACC Cardiovasc Interv 2016; 9:1649-51. [PMID: 27539684 DOI: 10.1016/j.jcin.2016.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 07/01/2016] [Indexed: 10/21/2022]
Affiliation(s)
| | - William E Boden
- Clinical Trials Network, VA New England Healthcare System, Boston, Massachusetts.
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Motivala AA, Parikh V, Roe M, Dai D, Abbott JD, Prasad A, Mukherjee D. Predictors, Trends, and Outcomes (Among Older Patients ≥65 Years of Age) Associated With Beta-Blocker Use in Patients With Stable Angina Undergoing Elective Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2016; 9:1639-48. [DOI: 10.1016/j.jcin.2016.05.048] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/29/2016] [Accepted: 05/19/2016] [Indexed: 02/01/2023]
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Lin MJ, Chen CY, Lin HD, Lin CS, Wu HP. Prognostic Significance of Central Pulse Pressure for Mortality in Patients With Coronary Artery Disease Receiving Repeated Percutaneous Coronary Intervention. Medicine (Baltimore) 2016; 95:e3218. [PMID: 27043689 PMCID: PMC4998550 DOI: 10.1097/md.0000000000003218] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Coronary artery disease (CAD) is a life-threatening medical emergency which needs urgent medical attention. Percutaneous coronary intervention (PCI) is common and necessary for patients with CAD, but it has not completely evaluated in cases with repeated PCI. Therefore, the aim of this study was to examine the risk factors and prognosis in patients with CAD requiring repeated PCI. This is a prospective observational study. A total of 1126 patients with CAD requiring PCI took part in this study. Clinical parameters including baseline characteristics, hemodynamic data, location of vascular lesions, SYNTAX score, left ventricular ejection fraction, central pulse pressure (CPP), central aortic systolic pressure (CSP), risk factors, and invasive strategies were analyzed to identify the risk factors for patients requiring repeated PCI. We further analyzed the prognosis, including risk for myocardial infarction (MI), cardiovascular (CV) mortality, and all-cause mortality, in patients with repeated PCI. Among patients with PCI, 276 received repeated PCI. Patients in the repeated PCI group had a higher CPP (66.7 vs 62.5 mm Hg; P = 0.006), CSP (139.9 vs 135.9 mm Hg; P = 0.017), and male preponderance (P = 0.012). Drugs including diuretics, beta-blockers (BBs), angiotensin-converting enzyme inhibitors (ACEIs), and aspirin were all used more frequently in the repeated PCI group (all P < 0.05). Freedom from MI was lower in the repeated PCI group than in the single PCI group (P < 0.001). Logistic regression revealed that CPP, CSP, number of diseased vessels, male sex, usage of diuretics, BBs, ACEIs, and MI were all predictors for requiring repeated PCI (all P < 0.05). In addition, CPP was a predictor for MI attack, CV mortality, and all-cause mortality in the repeated PCI group (P = 0.010, P = 0.041, P = 0.004, respectively). Elevated CPP, CSP, male sex, multiple diseased vessels, and the usage of diuretics, BBs, ACEIs, and MI were predictors for repeated PCI. Most importantly, CPP was strongly associated with MI attack, CV mortality, and all-cause mortality, and could serve as a prognostic parameter for mortality in patients with CAD after performing repeated PCI.
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Affiliation(s)
- Mao-Jen Lin
- From the Institue of Medicine(M-JL,C-SL),Chung-Shan Medical University, Taichung;Division of Cardiology (M-JL,H-DL), Department of Medicine, Taichung Tzu-Chi Hospital,the Buddhist Tzu-Chi Medical Foundation,Taichung; Department of Medicine (M-JL), School of Medicine, Tzu Chi University, Hualien; Division of Emergency Medicine (C-YC), Department of Pediatrics, Changhua Christian Hospital, Changhua; School of Medicine (C-YC), Kaohsiung Medical University, Kaohsiung; School of Medicine (C-YC, C-SL), Chung-Shan Medical University; Department of Internal Medicine (C-SL), Chung-Shan Medical University Hospital, Taichung; Division of Pediatric General Medicine (H-PW), Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan; and College of Medicine (H-PW), Chang Gung University, Taoyuan, Taiwan, China
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16
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Bernal DDL, Bereznicki LRE, Chalmers L, Castelino RL, Thompson A, Davidson PM, Peterson GM. Medication Adherence Following Acute Coronary Syndrome: Does One Size Fit All? Am J Cardiovasc Drugs 2016; 16:9-17. [PMID: 26547866 DOI: 10.1007/s40256-015-0149-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Guideline-based management of acute coronary syndrome (ACS) is well established, yet some may challenge that strict implementation of guideline recommendations can limit the individualization of therapy. The use of all recommended medications following ACS places a high burden of responsibility and cost on patients, particularly when these medications have not been previously prescribed. Without close attention to avoiding non-adherence to these medications, the full benefits of the guideline recommendations will not be realized in many patients. Using a case example, we discuss how the recognition of adherence barriers can be an effective and efficient process for identifying patients at risk of non-adherence following ACS. For those identified as at risk, the World Health Organization's model of adherence barriers is explored as a potentially useful tool to assist with individualization of therapy and promotion of adherence.
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Fischer-Rasokat U, Honold J, Lochmann D, Wolter S, Liebetrau C, Fichtlscherer S, Möllmann H, Spyridopoulos I, Hamm CW. β-Blockers and ivabradine differentially affect cardiopulmonary function and left ventricular filling index. Clin Res Cardiol 2015; 105:527-34. [PMID: 26687495 DOI: 10.1007/s00392-015-0950-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 12/07/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Patients with left ventricular (LV) diastolic dysfunction are characterized by exertional dyspnoea. Heart rate (HR) reduction by β-blockers can improve exercise tolerance by prolonging LV filling, but their negative inotropic and lusitropic properties can be detrimental in this disease. We tested the effects of administering ivabradine, a HR-lowering drug without impact on cardiac kinetics that may favorably affect diastolic function. METHODS Twenty-four patients with coronary artery disease (CAD) and normal LV ejection fraction on chronic β-blocker therapy were included. NT-proBNP serum levels were determined prior to and after cardiopulmonary exercise. β-Blockers were then replaced by ivabradine and patients were re-tested after 6 weeks. Patients were initially classified as having a low (E/e' ≤ 8; n = 11) or high (E/e' > 8; n = 13) LV filling index. RESULTS E/e' significantly decreased during ivabradine therapy in patients with high E/e' (10.7 ± 2.9 vs. 8.9 ± 1.7; p < 0.01), whereas no difference occurred in patients with low E/e' (6.4 ± 0.7 vs. 6.5 ± 1.1; p = ns). With ivabradine, patients with high E/e' had an increased oxygen uptake at the anaerobic threshold (from 10.8 ± 1.4 to 11.8 ± 1.9 ml/min/kg; p < 0.05) and a steeper slope of the initial oxygen pulse curve (from 293 ± 109 to 359 ± 117 µl/beat/kg/W; p < 0.05). Moreover, patients with high E/e' had lower NT-proBNP serum levels at rest (169 ± 207 vs. 126 ± 146 pg/ml; p < 0.05) and after exercise (190 ± 256 vs. 136 ± 162 pg/ml; p < 0.05) during ivabradine therapy. CONCLUSIONS In patients with CAD and elevated E/e', switching therapy from β-blockers to ivabradine may cause a reduction in LV filling pressures and an improved stroke volume response to exercise.
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Affiliation(s)
- Ulrich Fischer-Rasokat
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231, Bad Nauheim, Germany.
| | - Jörg Honold
- Department of Cardiology, University Hospital of the Goethe University, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Denise Lochmann
- Department of Cardiology, University Hospital of the Goethe University, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Sebastian Wolter
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231, Bad Nauheim, Germany
| | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231, Bad Nauheim, Germany
| | - Stephan Fichtlscherer
- Department of Cardiology, University Hospital of the Goethe University, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Helge Möllmann
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231, Bad Nauheim, Germany
| | - Ioakim Spyridopoulos
- Department of Cardiology, University Hospital of the Goethe University, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231, Bad Nauheim, Germany
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18
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Affiliation(s)
- E E van der Wall
- Interuniversity Cardiology Institute of the Netherlands (ICIN) - Netherlands Heart Institute (NHI), P.O. Box 19258, 3501 DG, Utrecht, the Netherlands,
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Bangalore S, Bhatt DL, Steg PG, Weber MA, Boden WE, Hamm CW, Montalescot G, Hsu A, Fox KAA, Lincoff AM. β-blockers and cardiovascular events in patients with and without myocardial infarction: post hoc analysis from the CHARISMA trial. Circ Cardiovasc Qual Outcomes 2014; 7:872-81. [PMID: 25271049 DOI: 10.1161/circoutcomes.114.001073] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The long-term efficacy of β-blockers in patients with and without myocardial infarction (MI) is controversial. METHODS AND RESULTS This is post hoc analysis from the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) trial of 4772 patients with prior MI, 7804 patients with known atherothrombosis, and 2101 patients with risk factors alone but without heart failure. Primary outcome was a composite of nonfatal MI, stroke, or cardiovascular mortality. The cohorts were divided into 2 groups based on baseline β-blocker use. In the propensity score-matched prior MI cohort, after 28 months of follow-up, β-blocker use was associated with a 31% lower risk of the primary outcome (70 [7.1%] versus 100 [10.2%]; hazards ratio, 0.69; 95% confidence interval, 0.50-0.94; P=0.021), driven by a lower risk of recurrent MI (33 [3.4%] versus 48 [4.9%]; hazards ratio, 0.62; 95% confidence interval, 0.39-1.00; P=0.049) with no difference in mortality (52 [5.3%] versus 66 [6.7%]; P=0.20). In the known atherothrombotic disease and the risk factors alone cohorts, β-blocker use was not associated with lower ischemic outcomes, whereas a trend toward a higher risk of stroke (3.5% versus 1.5%; hazards ratio, 2.13; 95% confidence interval, 0.92-4.92; P=0.079) was observed in the risk factors alone cohort. This higher stroke risk was significant in the regression model adjusted to the propensity score (hazards ratio, 2.69; 95% confidence interval, 1.33-5.44; P=0.006) and in the multivariable models. CONCLUSIONS β-blocker use in patients with prior MI but no heart failure was associated with a lower composite cardiovascular outcome driven by lower risk of recurrent MI with no difference in mortality. However, β-blocker use was not associated with lower cardiovascular events in those without MI, with a suggestion of inferior outcome with regard to stroke risk. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00050817.
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Affiliation(s)
- Sripal Bangalore
- From the New York University School of Medicine (S.B.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); AP-HP, Hôpital Bichat, Paris, France (P.G.S.); State University of New York, Downstate College of Medicine, Brooklyn (M.A.W.); Samuel Stratton VA Medical Center, Albany Medical College, NY (W.E.B.); Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany (C.W.H.); Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France (G.M.); Cleveland Clinic, OH (A.H., A.M.L.); and Centre for Cardiovascular Science, University of Edinburgh Duke of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.).
| | - Deepak L Bhatt
- From the New York University School of Medicine (S.B.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); AP-HP, Hôpital Bichat, Paris, France (P.G.S.); State University of New York, Downstate College of Medicine, Brooklyn (M.A.W.); Samuel Stratton VA Medical Center, Albany Medical College, NY (W.E.B.); Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany (C.W.H.); Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France (G.M.); Cleveland Clinic, OH (A.H., A.M.L.); and Centre for Cardiovascular Science, University of Edinburgh Duke of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Ph Gabriel Steg
- From the New York University School of Medicine (S.B.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); AP-HP, Hôpital Bichat, Paris, France (P.G.S.); State University of New York, Downstate College of Medicine, Brooklyn (M.A.W.); Samuel Stratton VA Medical Center, Albany Medical College, NY (W.E.B.); Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany (C.W.H.); Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France (G.M.); Cleveland Clinic, OH (A.H., A.M.L.); and Centre for Cardiovascular Science, University of Edinburgh Duke of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Michael A Weber
- From the New York University School of Medicine (S.B.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); AP-HP, Hôpital Bichat, Paris, France (P.G.S.); State University of New York, Downstate College of Medicine, Brooklyn (M.A.W.); Samuel Stratton VA Medical Center, Albany Medical College, NY (W.E.B.); Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany (C.W.H.); Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France (G.M.); Cleveland Clinic, OH (A.H., A.M.L.); and Centre for Cardiovascular Science, University of Edinburgh Duke of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - William E Boden
- From the New York University School of Medicine (S.B.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); AP-HP, Hôpital Bichat, Paris, France (P.G.S.); State University of New York, Downstate College of Medicine, Brooklyn (M.A.W.); Samuel Stratton VA Medical Center, Albany Medical College, NY (W.E.B.); Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany (C.W.H.); Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France (G.M.); Cleveland Clinic, OH (A.H., A.M.L.); and Centre for Cardiovascular Science, University of Edinburgh Duke of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Christian W Hamm
- From the New York University School of Medicine (S.B.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); AP-HP, Hôpital Bichat, Paris, France (P.G.S.); State University of New York, Downstate College of Medicine, Brooklyn (M.A.W.); Samuel Stratton VA Medical Center, Albany Medical College, NY (W.E.B.); Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany (C.W.H.); Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France (G.M.); Cleveland Clinic, OH (A.H., A.M.L.); and Centre for Cardiovascular Science, University of Edinburgh Duke of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Gilles Montalescot
- From the New York University School of Medicine (S.B.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); AP-HP, Hôpital Bichat, Paris, France (P.G.S.); State University of New York, Downstate College of Medicine, Brooklyn (M.A.W.); Samuel Stratton VA Medical Center, Albany Medical College, NY (W.E.B.); Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany (C.W.H.); Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France (G.M.); Cleveland Clinic, OH (A.H., A.M.L.); and Centre for Cardiovascular Science, University of Edinburgh Duke of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Amy Hsu
- From the New York University School of Medicine (S.B.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); AP-HP, Hôpital Bichat, Paris, France (P.G.S.); State University of New York, Downstate College of Medicine, Brooklyn (M.A.W.); Samuel Stratton VA Medical Center, Albany Medical College, NY (W.E.B.); Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany (C.W.H.); Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France (G.M.); Cleveland Clinic, OH (A.H., A.M.L.); and Centre for Cardiovascular Science, University of Edinburgh Duke of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - Keith A A Fox
- From the New York University School of Medicine (S.B.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); AP-HP, Hôpital Bichat, Paris, France (P.G.S.); State University of New York, Downstate College of Medicine, Brooklyn (M.A.W.); Samuel Stratton VA Medical Center, Albany Medical College, NY (W.E.B.); Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany (C.W.H.); Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France (G.M.); Cleveland Clinic, OH (A.H., A.M.L.); and Centre for Cardiovascular Science, University of Edinburgh Duke of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
| | - A Michael Lincoff
- From the New York University School of Medicine (S.B.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.); AP-HP, Hôpital Bichat, Paris, France (P.G.S.); State University of New York, Downstate College of Medicine, Brooklyn (M.A.W.); Samuel Stratton VA Medical Center, Albany Medical College, NY (W.E.B.); Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany (C.W.H.); Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France (G.M.); Cleveland Clinic, OH (A.H., A.M.L.); and Centre for Cardiovascular Science, University of Edinburgh Duke of Edinburgh, Edinburgh, United Kingdom (K.A.A.F.)
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Aspelin T, Eriksen M, Ilebekk A, Cataliotti A, Carlson CR, Lyberg T. β-blockade abolishes the augmented cardiac tPA release induced by transactivation of heterodimerised bradykinin receptor-2 and β2-adrenergic receptor in vivo. Thromb Haemost 2014; 112:951-9. [PMID: 25078038 DOI: 10.1160/th14-01-0059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 06/16/2014] [Indexed: 11/05/2022]
Abstract
Bradykinin (BK) receptor-2 (B2R) and β2-adrenergic receptor (β2AR) have been shown to form heterodimers in vitro. However, in vivo proofs of the functional effects of B2R-β2AR heterodimerisation are missing. Both BK and adrenergic stimulation are known inducers of tPA release. Our goal was to demonstrate the existence of B2R-β2AR heterodimerisation in myocardium and to define its functional effect on cardiac release of tPA in vivo. We further investigated the effects of a non-selective β-blocker on this receptor interplay. To investigate functional effects of B2R-β2AR heterodimerisation (i. e. BK transactivation of β2AR) in vivo, we induced serial electrical stimulation of cardiac sympathetic nerves (SS) in normal pigs that underwent concomitant BK infusion. Both SS and BK alone induced increases in cardiac tPA release. Importantly, despite B2R desensitisation, simultaneous BK infusion and SS (BK+SS) was characterised by 2.3 ± 0.3-fold enhanced tPA release compared to SS alone. When β-blockade (propranolol) was introduced prior to BK+SS, tPA release was inhibited. A persistent B2R-β2AR heterodimer was confirmed in BK-stimulated and non-stimulated left ventricular myocardium by immunoprecipitation studies and under non-reducing gel conditions. All together, these results strongly suggest BK transactivation of β2AR leading to enhanced β2AR-mediated release of tPA. Importantly, non-selective β-blockade inhibits both SS-induced release of tPA and the functional effects of B2R-β2AR heterodimerisation in vivo, which may have important clinical implications.
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Affiliation(s)
- Trude Aspelin
- Trude Aspelin, Institute for Experimental Medical Research, Oslo University Hospital, Ullevål, Postbox 4956 Nydalen, 0424 Oslo, Norway, Tel.: +47 22119685, Fax: +47 23016799, E-mail:
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[Risk factor management of coronary heart disease : what is evidence-based?]. Herz 2014; 39:483-94. [PMID: 24894947 DOI: 10.1007/s00059-014-4108-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In patients with coronary heart disease the further course of the disease can be substantially influenced by means of a targeted treatment of risk factors. A reduction of hospital referrals, an improvement in quality of life and an extension in life expectation by secondary prophylactic measures have been well documented. In addition to an optimized medicinal therapy, an often drastic change in lifestyle with a focus on a consistent abstinence from nicotine, a healthy diet and regular physical exercise is necessary. Data from healthcare research show that these targets are only insufficiently achieved. The implementation of current guidelines should therefore be rigorously applied. There is a need for research particularly with respect to the prognostic significance of beta blocker therapy for patients with stable coronary heart disease and preserved left ventricular function, the prognostic significance of targeted weight loss for overweight or obese coronary heart disease patients, the effectiveness of psychosocial interventions in the various patient groups and their implementation into routine care. Research is also necessary with respect to optimization of structured rehabilitation programs and improvement in patient compliance.
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Kohanim S, Sternberg P. Ophthalmic patient data registries: defining and improving quality and outcomes. Ophthalmology 2014; 121:619-21. [PMID: 24581753 DOI: 10.1016/j.ophtha.2013.12.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 12/23/2013] [Indexed: 10/25/2022] Open
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Das SK, Patel VB, Oudit GY. Beneficial effects of grape resveratrol on serum adiponectin and inflammation: clinical trial in patients with stable coronary artery disease: editorial to: "Grape resveratrol increases serum adiponectin and downregulates inflammatory genes in peripheral blood mononuclear cells: a triple-blind, placebo-controlled, one-year clinical trial in patients with stable coronary artery disease" by J. Tomé-Carneiro et al. Cardiovasc Drugs Ther 2013; 27:1-4. [PMID: 23292168 DOI: 10.1007/s10557-012-6434-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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