Beta-blocker prescription among Japanese cardiologists and its effect on various outcomes.
BACKGROUND
Beta-blockers are underprescribed for coronary artery disease (CAD) patients in Japan. Considering the vast amount of evidence showing their benefits in this group of patients, the aim of the present study was to investigate the use of beta-blockers in a large cohort of CAD patients.


RESULTS
The 13,812 patients with angiographically confirmed CAD were followed up for 2.7 years. From this group, 4,160 (30.1%) patients were prescribed beta-blockers at the time of discharge. These patients were significantly more likely to have hypertension, hyperlipidemia, obesity, a family history of ischemic diseases and a higher number of diseased arteries. The rate of continuation for beta-blockers was 90.8%. A propensity score matching analysis showed no additional benefits of beta-blockers in reducing all-cause mortality, cardiac events and cerebrovascular events. Lipophilic beta-blockers were significantly more effective than hydrophilic ones in reducing all-cause mortality (hazard ratio 0.467, 95% confidence interval 0.247-0.880, P=0.019).


CONCLUSIONS
Despite the low prescription rate of beta-blockers for CAD patients among Japanese physicians, the continuation rate was relatively high. Lipophilic beta-blockers may be a better choice than hydrophilic beta-blockers in terms of mortality risk, although a randomized control study would need to be conducted to verify this assertion.
Kohro
Takahide
T
Department of Translational Research for Healthcare and Clinical Science, The University of Tokyo, Tokyo, Japan.
Hayashi
Dobun
D
Yamazaki
Tsutomu
T
Nagai
Ryozo
R
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000368:Aged; D044466:Asian People; D002309:Cardiology / Q000379:methods / Q000639:trends; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000401:mortality; D011307:Drug Prescriptions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy / Q000401:mortality; D006973:Hypertension / Q000188:drug therapy / Q000401:mortality; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000188:drug therapy / Q000401:mortality; D009765:Obesity / Q000188:drug therapy / Q000401:mortality; D057216:Propensity Score
D000319:Adrenergic beta-Antagonists