title: Drug treatment rates with beta-blockers and ACE-inhibitors/angiotensin receptor blockers and recurrences in takotsubo cardiomyopathy: A meta-regression analysis.
abstract: BACKGROUND
  In a recent paper Singh et al. analyzed the effect of drug treatment on recurrence of takotsubo cardiomyopathy (TTC) in a comprehensive meta-analysis. The study found that recurrence rates were independent of clinic utilization of BB prescription, but inversely correlated with ACEi/ARB prescription: authors therefore conclude that ACEi/ARB rather than BB may reduce risk of recurrence.
  
  
  METHODS
  We aimed to re-analyze data reported in the study, now weighted for populations' size, in a meta-regression analysis.
  
  
  RESULTS
  After multiple meta-regression analysis, we found a significant regression between rates of prescription of ACEi and rates of recurrence of TTC; regression was not statistically significant for BBs.
  
  
  CONCLUSIONS
  On the bases of our re-analysis, we confirm that rates of recurrence of TTC are lower in populations of patients with higher rates of treatment with ACEi/ARB. That could not necessarily imply that ACEi may prevent recurrence of TTC, but barely that, for example, rates of recurrence are lower in cohorts more compliant with therapy or more prescribed with ACEi because more carefully followed. Randomized prospective studies are surely warranted.
authors.affiliation: Ospedali Riuniti University Hospital, University of Foggia, Foggia, Italy; Department of Medical & Surgical Sciences, University of Foggia, Italy. Electronic address: natale.brunetti@unifg.it.
authors.forename: Natale Daniele
authors.initials: ND
authors.lastname: Brunetti
authors.affiliation: Asklepios Klinik Sankt Georg, Hamburg, Germany.
authors.forename: Francesco
authors.initials: F
authors.lastname: Santoro
authors.affiliation: Ospedale San Paolo, Bari, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: De Gennaro
authors.affiliation: Ospedali Riuniti University Hospital, University of Foggia, Foggia, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Correale
authors.affiliation: Ospedali Riuniti University Hospital, University of Foggia, Foggia, Italy; Department of Medical & Surgical Sciences, University of Foggia, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gaglione
authors.affiliation: Ospedali Riuniti University Hospital, University of Foggia, Foggia, Italy; Department of Medical & Surgical Sciences, University of Foggia, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Di Biase
mesh_terms: D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D011156:Population Density; D011446:Prospective Studies; D012008:Recurrence; D012044:Regression Analysis; D054549:Takotsubo Cardiomyopathy / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: ACE-inhibitors; Beta-blockers; Meta-regression; Recurrence; Stress cardiomyopathy; Takotsubo cardiomyopathy