Effect of Beta-Blocker on Long-Term Major Cardiovascular Events in High Atherosclerotic Risk Population

Nichanan Osataphan; Kamol Udol; Khanchai Siriwattana; Bancha Sukanandachai; Siriluck Gunaparn; Wachiranun Sirikul; Arintaya Phrommintikul; Wanwarang Wongcharoen

doi:10.1007/s10557-023-07502-8

Effect of Beta-Blocker on Long-Term Major Cardiovascular Events in High Atherosclerotic Risk Population

Cardiovasc Drugs Ther. 2023 Aug 18. doi: 10.1007/s10557-023-07502-8. Online ahead of print.

Authors

Nichanan Osataphan¹, Kamol Udol², Khanchai Siriwattana³, Bancha Sukanandachai⁴, Siriluck Gunaparn¹, Wachiranun Sirikul⁵, Arintaya Phrommintikul^{6

7}, Wanwarang Wongcharoen⁸

Affiliations

¹ Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
² Division of Cardiovascular and Metabolic Disease Prevention, Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
³ Department of Medicine, Nakornping Hospital, Chiang Mai, Thailand.
⁴ Department of Internal Medicine, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand.
⁵ Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
⁶ Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand. arintayap@yahoo.com.
⁷ Center for Medical Excellence, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand. arintayap@yahoo.com.
⁸ Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand. bwanwarang@yahoo.com.

PMID: 37594650
DOI: 10.1007/s10557-023-07502-8

Abstract

Purpose: Beta-blocker is a frequently used medication in cardiovascular diseases. However, long-term benefit of beta-blocker in patients with preserved left ventricular ejection function (LVEF) on major adverse cardiovascular events (MACEs) is uncertain.

Methods: The Cohort Of patients with high Risk for cardiovascular Events (CORE-Thailand) was a prospective study that enrolled Thai patients with high atherosclerotic risk including multiple atherosclerotic risk factors and established atherosclerotic cardiovascular diseases. Baseline demographic data, co-morbidities and medication were recorded. Patients were followed for 5 years. Patients with LVEF<50% were excluded. Primary outcome was the effect of beta-blocker on the occurrence of MACEs including all-cause death, non-fatal myocardial infarction and non-fatal stroke (3P-MACEs). Propensity score matching was used to control confounding factors.

Results: There was a total of 8513 patients in the pre-matched cohort, 4418 were taking beta-blocker and 4095 were not. After adjustment of confounders, beta-blocker was an independent predictor of 3P-MACEs (adjusted HR 1.29;95% CI 1.12-1.49;p<0.001). After propensity score matching, 4686 patients remained in the post-matched cohort. Propensity score analysis showed consistent results in which patient taking beta-blocker had higher risk of 3P-MACEs (adjusted HR 1.29;95% CI 1.10-1.53;p=0.002). Subgroup analysis in patients with coronary artery disease (CAD) indicated that taking beta-blocker did not increase the incidence of 3P-MACEs (adjusted HR 0.99;95% CI 0.76-1.29) while those without CAD did (adjusted HR 1.51; 95% CI, 1.22-1.86;p-interaction=0.015).

Conclusion: In patients with high atherosclerotic cardiovascular risk, taking beta-blockers had a higher risk of 3P-MACEs. Care should be taken when prescribing beta-blockers to patients without a clear indication.

Trial registration: TCTR20130520001 registered in Thai Clinical Trials Registry (TCTR) https://www.thaiclinicaltrials.org/ , date of registration 20 May 2013.

Keywords: Atherosclerosis; Beta-blocker; Cardiovascular risk factors; Coronary artery disease; Peripheral artery disease; Stroke.