Associations between β-blocker therapy and cardiovascular outcomes in patients with diabetes and established cardiovascular disease.

Abstract

BACKGROUND:

The effects of β-blocker therapy in patients with type 2 diabetes (T2D) and established atherosclerotic cardiovascular disease (ASCVD) are unclear. We sought to evaluate associations between β-blocker use in T2D with ASCVD and cardiovascular (CV) outcomes.

METHODS:

In patients with T2D and ASCVD enrolled in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS), an inverse probability of treatment-weighted Cox proportional hazards model was used to examine the association between baseline β-blocker therapy (at randomization) and the primary CV composite (defined as CV death, non-fatal myocardial infarction [MI], non-fatal stroke, or hospitalization for unstable angina), including in subgroups with prior MI and heart failure (HF); other outcomes evaluated included individual components of the primary composite, hospitalization for HF, and severe hypoglycemic events.

RESULTS:

Of the 14,671 patients randomized, 9322 (64%) were on a β-blocker at baseline; these patients were more likely to have prior MI or HF. Over a median 3.0 (25th, 75th percentile: 2.2, 3.6) years, the risk of the primary CV composite was significantly higher with baseline β-blocker use versus no β-blocker use (4.5 vs. 3.4 events/100-patient years, adjusted hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.05-1.29); no significant interaction was noted for patients with versus without prior MI or HF. Baseline β-blocker use was not associated with risks for severe hypoglycemic events (HR 1.14, 95% CI 0.88-1.48).

CONCLUSIONS:

In this observational analysis of T2D and ASCVD, baseline β-blocker use was not associated with risks for severe hypoglycemia yet also was not associated with CV risk reduction over 3 years of follow-up, supporting a randomized examination of chronic β-blocker therapy in this patient population. (TECOS ClinicalTrials.gov number, NCT00790205).

• Authors: Jay S Shavadia, Yinggan Zheng, Jennifer B Green, Paul W Armstrong, Cynthia M Westerhout, Darren K McGuire, Jan H Cornel, Rury R Holman, Eric D Peterson
• Journal: American heart journal (Am Heart J) Vol. 218 Pg. 92-99 (12 2019) ISSN: 1097-6744 [Electronic] United States
• PMID: 31715435 (Publication Type: Journal Article, Multicenter Study, Observational Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Chemical References

• Adrenergic beta-Antagonists
• Hypoglycemic Agents
• Sitagliptin Phosphate

Topics

• Adrenergic beta-Antagonists (adverse effects, therapeutic use)
• Aged
• Angina, Unstable (drug therapy)
• Atherosclerosis (drug therapy, prevention & control)
• Atrial Fibrillation (drug therapy)
• Cardiovascular Diseases (complications, drug therapy, mortality, prevention & control)
• Cause of Death
• Diabetes Mellitus, Type 2 (complications, drug therapy)
• Double-Blind Method
• Female
• Heart Failure (drug therapy)
• Hospitalization
• Humans
• Hypoglycemia (chemically induced)
• Hypoglycemic Agents (therapeutic use)
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Myocardial Infarction (etiology)
• Proportional Hazards Models
• Sitagliptin Phosphate (therapeutic use)
• Stroke (etiology)
• Treatment Outcome