β-blockers and progression of coronary atherosclerosis: Pooled analysis of 4 intravascular ultrasonography trials

Ilke Sipahi, E. Murat Tuzcu, Katherine E. Wolski, Stephen J. Nicholls, Paul Schoenhagen, Bo Hu, Craig Balog, Mehdi Shishehbor, William A. Magyar, Timothy D. Crowe, Samir Kapadia, Steven E. Nissen

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Abstract

Background: In patients with myocardial infarction, β-adrenergic blockers reduce recurrent myocardial infarction and total mortality rates. However, whether a direct influence of β-blockers on coronary atherosclerosis contributes to reduced recurrent myocardial infarction and total mortality rates is not known. Objective: To assess whether β-blocker therapy is associated with reduced atheroma progression in adults with known coronary artery disease. Design: Post hoc, pooled analysis of individual patient data from 4 intravascular ultrasonography (IVUS) trials. Setting: Four IVUS trials conducted in the United States, Europe, and Australia. Patients: 1515 patients with coronary artery disease. Intervention: The original trials used 3 different statins, a calcium-channel blocker, an angiotensin-converting enzyme inhibitor, or an acyl coenzyme A-cholesterol acyltransferase inhibitor. Measurements: Changes in atheroma volume, as determined by IVUS after adjustment for possible confounders by using linear mixed-effects models, were compared in patients who did and did not receive concomitant β-blocker treatment. Results: Patients who received β-blockers (n = 1154) were more likely to have histories of myocardial infarction, angina, and hypertension than were patients who did not receive β-blockers (n = 361). The estimated annual change in atheroma volume was statistically significantly less in patients who received β-blockers. This was true for univariate and multivariable analyses that controlled for history of myocardial infarction, angina, and hypertension (mean [±SE] atheroma volume, -2.4 ± 0.5 mm 3/y in treated patients vs. -0.4 ± 0.8 mm3/y in untreated patients; P = 0.034). Accordingly, atheroma volume statistically significantly decreased at follow-up IVUS in patients who received β-blockers (P < 0.001) and did not change in patients who did not receive β-blockers (P = 0.86). Additional adjustments for low-density lipoprotein cholesterol level, concomitant medications, and clinical trial did not change the results. Limitations: Patients were not randomly assigned to β-blocker therapy, and interventions other than β-blocker therapy could have influenced the changes in atheroma volume. Whether progression rate of atherosclerosis as detected by IVUS predicts cardiovascular outcomes is unknown. Conclusions: The analysis demonstrates that β-blockers can slow progression of coronary atherosclerosis. The findings provide additional support for the current clinical guidelines advocating long-term use of β-blockers to treat most forms of coronary artery disease.

Original languageEnglish
Pages (from-to)10-18
Number of pages9
JournalAnnals of internal medicine
Volume147
Issue number1
DOIs
Publication statusPublished - 3 Jul 2007
Externally publishedYes

ASJC Scopus subject areas

  • Internal Medicine

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