CNN: New studies say beta blockers don't work

Thank you for the heads up about beta blockers not working well for a sub group of women.

One takeaway when I read this article is that gender has a lot to do with how people respond to medication. I’m not sure I appreciate just how much of a difference gender makes. I am encouraged to see more information about it.

Another, that there is a specific subgroup of women that did benefit from a routine use of beta-blockers in the New England Journal of Medicine study, finding “about a 25% reduction in the primary endpoint, which was a composite of new heart attacks, heart failure and all-cause death.”

The referenced study is titled specifically, Beta-Blockers after Myocardial Infarction Without Reduced Ejection Fraction: https://www.nejm.org/doi/full/10.1056/NEJMoa2504735

I didn’t read the entire study because it requires setting up an account and I don’t have one. Did you read the study, njx58? What are your takeaways after reading the study/article?

If you go to that link and click on PDF, you'll be able to see it.

There are a number of caveats in the paper, and I suspect that the news article played up some things while ignoring others, which is not uncommon when research papers get digested for the news. They certainly weren't dismissing beta blockers completely.

I read the study summary in NEJM as well as an earlier study summary :
https://pmc.ncbi.nlm.nih.gov/articles/PMC10497890/#sec8
This is regarding patients with myocardial infarction (heart attack) and the conclusion is that beta-blockers WERE the treatment of choice before the introduction of new classes of drugs. Now, there are other choices which seem to be better, if the heart ejection fraction is at or above 50% post-infarction.

Here is the opening premise from the abstract:
"Most of the evidences for beneficial effects of beta-blockers in patients with acute myocardial infarction (AMI) were from the clinical studies published in the pre-reperfusion era when anti-platelet drugs, statins or inhibitors of renin-angiotensin-aldosterone system which are known to reduce cardiovascular mortality of patients with AMI were not introduced. In the reperfusion era, beta-blockers’ benefit has not been clearly shown except in patients with reduced ejection fraction (EF; ≤40%). In the era of the early reperfusion therapy for AMI, a number of patients with mildly reduced EF (>40%, < 50%) or preserved EF (≥50%) become increasing. However, because no randomized clinical trials are available until now, the benefit and the optimal duration of oral treatment with beta-blockers in patients with mildly reduced or preserved EF are questionable."

The conclusion is that the use of beta-blockers after a heart attack needs to be studied and its use matched to each patient. One must remember that there are other reasons for using a beta-blocker, like controlling heart rate in some people, and probably others I am not aware of.

Bottom line - beta-blockers, like many other drugs, are not for everyone. Great for awareness, but it is not a drug that should be banished to the annals of pharmacology or cardiology at this time.