Beta-blockers and progression of coronary atherosclerosis: pooled analysis of 4 intravascular ultrasonography trials.
BACKGROUND
In patients with myocardial infarction, beta-adrenergic blockers reduce recurrent myocardial infarction and total mortality rates. However, whether a direct influence of beta-blockers on coronary atherosclerosis contributes to reduced recurrent myocardial infarction and total mortality rates is not known.


OBJECTIVE
To assess whether beta-blocker therapy is associated with reduced atheroma progression in adults with known coronary artery disease.


METHODS
Post hoc, pooled analysis of individual patient data from 4 intravascular ultrasonography (IVUS) trials.


METHODS
Four IVUS trials conducted in the United States, Europe, and Australia.


METHODS
1515 patients with coronary artery disease.


METHODS
The original trials used 3 different statins, a calcium-channel blocker, an angiotensin-converting enzyme inhibitor, or an acyl coenzyme A-cholesterol acyltransferase inhibitor.


METHODS
Changes in atheroma volume, as determined by IVUS after adjustment for possible confounders by using linear mixed-effects models, were compared in patients who did and did not receive concomitant beta-blocker treatment.


RESULTS
Patients who received beta-blockers (n = 1154) were more likely to have histories of myocardial infarction, angina, and hypertension than were patients who did not receive beta-blockers (n = 361). The estimated annual change in atheroma volume was statistically significantly less in patients who received beta-blockers. This was true for univariate and multivariable analyses that controlled for history of myocardial infarction, angina, and hypertension (mean [+/-SE] atheroma volume, -2.4 +/- 0.5 mm3/y in treated patients vs. -0.4 +/- 0.8 mm3/y in untreated patients; P = 0.034). Accordingly, atheroma volume statistically significantly decreased at follow-up IVUS in patients who received beta-blockers (P < 0.001) and did not change in patients who did not receive beta-blockers (P = 0.86). Additional adjustments for low-density lipoprotein cholesterol level, concomitant medications, and clinical trial did not change the results.


CONCLUSIONS
Patients were not randomly assigned to beta-blocker therapy, and interventions other than beta-blocker therapy could have influenced the changes in atheroma volume. Whether progression rate of atherosclerosis as detected by IVUS predicts cardiovascular outcomes is unknown.


CONCLUSIONS
The analysis demonstrates that beta-blockers can slow progression of coronary atherosclerosis. The findings provide additional support for the current clinical guidelines advocating long-term use of beta-blockers to treat most forms of coronary artery disease.
Sipahi
Ilke
I
Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Tuzcu
E Murat
EM
Wolski
Katherine E
KE
Nicholls
Stephen J
SJ
Schoenhagen
Paul
P
Hu
Bo
B
Balog
Craig
C
Shishehbor
Mehdi
M
Magyar
William A
WA
Crowe
Timothy D
TD
Kapadia
Samir
S
Nissen
Steven E
SE
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018084:Ultrasonography, Interventional
D000319:Adrenergic beta-Antagonists