My heart sank yesterday when I saw the story that beta blockers help “only half of heart attack patients,” according to a new study.
Thousands of people in the UK take these medicines, not only after a heart attack, but also for heart rhythm problems, high blood pressure and anxiety. And I’m afraid there will be many who will misunderstand this and think, right, I didn’t want to take beta blockers anyway and just stop taking them.
And yet these medications can and do save lives.
If you missed it, a quick summary: The story emerged from a major conference in the US, hosted by the American College of Cardiology.
A prestigious meeting, without a doubt, although the research itself has just been published in the also prestigious New England Journal of Medicine. Two ticks.
Thousands of people in the UK take beta blockers, not only after a heart attack, but also for heart rhythm problems, high blood pressure and anxiety.
The study involved 5,000 patients who had recently had a heart attack and received beta blockers or no treatment. They were followed up after three and a half years and the results showed that in about half of the patients taking beta blockers, the treatment did not reduce their risk of having another heart attack or dying prematurely.
In some ways, this finding is not so new. Over the past ten years, reviews have suggested that beta-blockers made no difference in outcomes for some patients, but that they do have a place when prescribed carefully and appropriately.
And worse: A previous study found that heart attack patients who received beta blockers were more likely to suffer a stroke at some point.
But in my opinion, the risk was that people who had had a heart attack were already at risk of having a stroke, not because of the medications but because of whatever had caused their heart attack in the first place.
So what does this mean for you?
First, I need to explain how beta blockers work. Basically, they interfere with adrenaline and other hormones that raise heart rate and blood pressure, thereby reducing the strain on the heart.
That is why they are given to heart attack patients, about half of whom will later develop heart failure, where damage to the heart caused by the heart attack means it cannot pump blood efficiently throughout the body. It becomes increasingly weaker, causing symptoms such as shortness of breath and fluid retention, and increasing the risk of premature death.
It is these heart failure patients who did benefit from beta blockers, according to the new study.
But the drugs are also given to thousands of people with heart failure (caused by decreased heart muscle function due to clogged arteries or damage from high blood pressure, for example).
And they are prescribed for patients with abnormal heart rhythms, such as rapid atrial fibrillation (where the heart beats erratically and quickly), which, like heart failure, are very common.
Beta blockers are also given for anxiety and high blood pressure. The problem, especially with the latter, is that you may not have symptoms until you experience a cardiovascular problem, such as a heart attack or stroke.
Beta blockers work by interfering with adrenaline and other hormones that raise heart rate and blood pressure, thereby reducing the strain on the heart. That’s why they are given to heart attack patients, about half of whom will develop heart failure later.
For this reason, people are very quick to stop taking hypertension medications as they don’t see the point because they don’t have symptoms.
My concern is that these and other patients who really need the medications will see this story and stop taking this important medication.
What about other heart attack patients in the new study who don’t have heart failure? Don’t they need beta blockers anymore?
The main line of the study is powerful. However, there are several caveats to the findings. For example, we don’t know how long patients taking beta-blockers took them (the researchers only had this information for the first year). And maybe, like people who take blood pressure pills, they didn’t feel any different and stopped taking them.
There was also no placebo group in the trial, and the trial was not “blinded,” the gold standard for new treatments (this is where patients are randomly assigned to receive the treatment being tested or a placebo: and they and their doctors don’t know what they are getting), although we know that the placebo effect is strong.
Additionally, the study has been criticized because only 22.5 percent of the participants were women. The fact is that cardiovascular disease is a leading cause of death among women, and it’s not good enough today that researchers have apparently said that other studies are equally biased.
One of the main complaints about beta blockers is their side effects, such as nausea and tiredness. In my clinical experience, modern beta blockers like bisoprolol seem to be more or less free of side effects. Very rarely have I had to take a patient off medication for this reason.
And research has found that medical treatment for angina, coronary heart disease, and after a heart attack (with statins, aspirin, beta blockers, etc.) is as effective in preventing premature death as surgery to insert a stent or a cardiac bypass.
The bottom line is, as always, definitely don’t stop taking medications (in this case, beta blockers) without talking to your doctor first.
