Is There a Negative Interaction Between Use of Beta-Blocker and Statins on Atherothrombosis Risk?

There is no interaction between beta-blocker use and the benefit of statins on cardiovascular outcomes, according to a research letter published Aug. 18 in the Journal of the American College of Cardiology.

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Given that many patients receive both types of agents, particularly as a secondary means of prevention after acute coronary syndromes, the investigation, led by Jérémie Abtan, MD, Département Hospitalo-Universitaire Fibrosis-Inflammation-REmodelling: Hôpital Bichat, and INSERM U-1148, Université Paris-Diderot, Paris, France, sought to determine whether a negative interaction exists between beta-blocker use and the benefit of statins in patients with atherothrombosis treated in primary or secondary prevention.

The study examined 65,181 patients in the REACH Registry trial, which enrolled consecutive individuals aged 45 years or older with established coronary artery disease, cerebrovascular disease, or peripheral arterial disease, or with at least three atherothrombotic risk factors. Within the cohort, 45,312 patients (69.5 percent) were treated by statins and 30,971 patients (47.5 percent) by beta-blockers. Statin use was found to be associated with lower adjusted primary endpoint (composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke) regardless of whether patients were on beta-blockers, 942 events (18 percent) vs. 2,346 events (13.6 percent), or not on beta-blockers, 1,623 events (16.9 percent) vs. 1,877 events (12.5 percent). Consistent results were found across all patients subsets with no evidence of negative interaction.

Despite limitations such as the fact that the type of beta-blocker was not collected, and that it has been suggested that a negative interaction of beta-blockers may be more marked for non-selective beta-blocker, the authors conclude that “in this large international contemporary cohort of patients with or at risk for atherothrombosis, there was no evidence of a negative interaction between beta-blockers and the benefits of statins on cardiovascular outcomes.”

Keywords: Inflammation, Registries, Myocardial Infarction, Acute Coronary Syndrome, Stroke, Secondary Prevention, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Peripheral Arterial Disease, Risk Factors

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