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Effect of Beta-Blocker on Long-Term Major Cardiovascular Events in High Atherosclerotic Risk Population

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Cardiovascular Drugs and Therapy Aims and scope Submit manuscript

Abstract

Purpose

Beta-blocker is a frequently used medication in cardiovascular diseases. However, long-term benefit of beta-blocker in patients with preserved left ventricular ejection function (LVEF) on major adverse cardiovascular events (MACEs) is uncertain.

Methods

The Cohort Of patients with high Risk for cardiovascular Events (CORE-Thailand) was a prospective study that enrolled Thai patients with high atherosclerotic risk including multiple atherosclerotic risk factors and established atherosclerotic cardiovascular diseases. Baseline demographic data, co-morbidities and medication were recorded. Patients were followed for 5 years. Patients with LVEF<50% were excluded. Primary outcome was the effect of beta-blocker on the occurrence of MACEs including all-cause death, non-fatal myocardial infarction and non-fatal stroke (3P-MACEs). Propensity score matching was used to control confounding factors.

Results

There was a total of 8513 patients in the pre-matched cohort, 4418 were taking beta-blocker and 4095 were not. After adjustment of confounders, beta-blocker was an independent predictor of 3P-MACEs (adjusted HR 1.29;95% CI 1.12-1.49;p<0.001). After propensity score matching, 4686 patients remained in the post-matched cohort. Propensity score analysis showed consistent results in which patient taking beta-blocker had higher risk of 3P-MACEs (adjusted HR 1.29;95% CI 1.10-1.53;p=0.002). Subgroup analysis in patients with coronary artery disease (CAD) indicated that taking beta-blocker did not increase the incidence of 3P-MACEs (adjusted HR 0.99;95% CI 0.76-1.29) while those without CAD did (adjusted HR 1.51; 95% CI, 1.22-1.86;p-interaction=0.015).

Conclusion

In patients with high atherosclerotic cardiovascular risk, taking beta-blockers had a higher risk of 3P-MACEs. Care should be taken when prescribing beta-blockers to patients without a clear indication.

Trial registration

TCTR20130520001 registered in Thai Clinical Trials Registry (TCTR) https://www.thaiclinicaltrials.org/, date of registration 20 May 2013.

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Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgments

We would like to express our appreciation for all the efforts and contributions to the study support from the investigators of CORE registry, Thailand. This study was supported by The Heart Association of Thailand, National Research Council of Thailand (NRCT) and Health Systems Research Institute (HSRI).

Funding

This study was supported by The Heart Association of Thailand, National Research Council of Thailand (NRCT) and Health Systems Research Institute (HSRI). The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand

    Nichanan Osataphan, Siriluck Gunaparn, Arintaya Phrommintikul & Wanwarang Wongcharoen

  2. Division of Cardiovascular and Metabolic Disease Prevention, Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Kamol Udol

  3. Department of Medicine, Nakornping Hospital, Chiang Mai, Thailand

    Khanchai Siriwattana

  4. Department of Internal Medicine, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand

    Bancha Sukanandachai

  5. Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Wachiranun Sirikul

  6. Center for Medical Excellence, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand

    Arintaya Phrommintikul

Authors
  1. Nichanan Osataphan
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Contributions

NO performed statistical analysis, wrote the manuscript, tables, and figures. KU, KS, BS revising it critically for important intellectual content. SG collected and re-checked the data prior to the analysis. WS performed statistical analysis and figures. WW, AP substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of the data for the work. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding authors

Correspondence to Arintaya Phrommintikul or Wanwarang Wongcharoen.

Ethics declarations

Ethical Approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Joint Research Ethics Committee and Ministry of Public Health, Thailand (Approval Number COA-JREC 004/2011, date of approval 21 May 2011).

Consent to Participate

Informed consent was obtained from all patients prior to the commencement of the study.

Consent for Publication

Not applicable.

Competing Interests

The authors have no relevant financial or non-financial interests to disclose.

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Osataphan, N., Udol, K., Siriwattana, K. et al. Effect of Beta-Blocker on Long-Term Major Cardiovascular Events in High Atherosclerotic Risk Population. Cardiovasc Drugs Ther (2023). https://doi.org/10.1007/s10557-023-07502-8

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