title: Beta-blockers and progression of coronary atherosclerosis: pooled analysis of 4 intravascular ultrasonography trials.
abstract: 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.
authors.affiliation: Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Ilke
authors.initials: I
authors.lastname: Sipahi
authors.forename: E Murat
authors.initials: EM
authors.lastname: Tuzcu
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Wolski
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Nicholls
authors.forename: Paul
authors.initials: P
authors.lastname: Schoenhagen
authors.forename: Bo
authors.initials: B
authors.lastname: Hu
authors.forename: Craig
authors.initials: C
authors.lastname: Balog
authors.forename: Mehdi
authors.initials: M
authors.lastname: Shishehbor
authors.forename: William A
authors.initials: WA
authors.lastname: Magyar
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Crowe
authors.forename: Samir
authors.initials: S
authors.lastname: Kapadia
authors.forename: Steven E
authors.initials: SE
authors.lastname: Nissen
mesh_terms: 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
chemical_list: D000319:Adrenergic beta-Antagonists