Usefulness of beta-blocker therapy in patients with non-insulin-dependent diabetes mellitus and coronary artery disease. Bezafibrate Infarction Prevention (BIP) Study Group.
The benefit of beta-blocker therapy in patients after myocardial infarction is well established. The use of beta blockers in the high-risk subgroup of patients with combined diabetes mellitus (DM) and coronary artery disease (CAD) remains controversial. From a database of 14,417 patients with chronic CAD who had been screened for participation in the Bezafibrate Infarction Prevention (BIP) study, 2,723 (19%) had non-insulin-dependent DM. Baseline characteristics and 3-year mortality were analyzed in patients with DM receiving (n = 911; 33%) and not receiving (n = 1,812; 67%) beta blockers. Total mortality during a 3-year follow-up was 7.8% in those receiving beta blockers compared with 14.0% in those who were not (a 44% reduction). A reduction in cardiac mortality of 42% between the 2 groups was also noted. Three-year survival curves showed significant differences in mortality with increasing divergence (p = 0.0001). After multiple adjustment, multivariate analysis identified beta-blocker therapy as a significant independent contributor to improved survival (relative risk = 0.58; 90% confidence interval 0.46 to 0.74). Within the diabetic population, the main benefit associated with beta-blocker therapy was observed in older patients, in those with a history of myocardial infarction, those with limited functional capacity, and those at lower risk. Thus, therapy with beta blockers appears to be associated with improved long-term survival in the high-risk subpopulation of patients with DM and CAD.
Jonas
M
M
Neufeld Cardiac Research Institute, Tel Hashomer, Israel.
Reicher-Reiss
H
H
Boyko
V
V
Shotan
A
A
Mandelzweig
L
L
Goldbourt
U
U
Behar
S
S
D000206:Actuarial Analysis; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D001629:Bezafibrate / Q000627:therapeutic use; D016022:Case-Control Studies; D003327:Coronary Disease / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors
D000319:Adrenergic beta-Antagonists; D000960:Hypolipidemic Agents; D001629:Bezafibrate