Beta blockers are drugs that work by blocking the heart’s beta-adrenergic receptors, reducing cardiac work and therefore improving cardiac compensation and survival. For this reason, for many years now, these drugs have been among the most used in the treatment of heart disease and in particular coronary disease and post-infarction. In fact, all the guidelines on the treatment of this pathology compulsorily provide for the use of beta blockers as a pillar to improve survival and reduce the probability of heart attack recurrence.
THE TEAM
In a study presented at the last Congress of the American College of Cardiology and just published in the New England Journal of Medicine, T. Yndigegn and the participants in the REDUCE-AMI trial, coordinated by the Karolinska Institute in Stockholm, question the very benefit of beta blockers in preventing a second heart attack or in reducing mortality in patients in whom the myocardial infarction was treated quickly and therefore the heart damage was not significant.
Cardiovascular diseases: central indicators, but to be optimized
THE CASES
Over 5000 patients enrolled between the first and seventh day after an acute myocardial infarction and who had a coronary angiography positive for coronary stenosis, but in whom the contractility of the cardiac muscle (assessed echocardiographically) was normal or at least not seriously reduced were studied. .
Approximately half of the patients underwent therapy including (as per heart attack guidelines) the use of beta blockers. In the other group, therapy was prescribed without the use of these drugs. After a follow-up period of approximately three and a half years, the incidence of deaths, recurrence of myocardial infarction and also the number of hospitalizations for atrial fibrillation, heart failure, stroke or operations were evaluated in both groups. for pace maker implant. The result is that there was no significant difference between the two groups for any of the variables considered.
On the other hand, there was no difference even for the adverse reactions sometimes caused by beta blockers, such as bradycardia, asthma or others. This study, which comes after other smaller studies which obtained similar results, clearly clarifies that in patients with recent myocardial infarction which however has not seriously reduced the contractility of the heart muscle, routine treatment with some drugs such as beta blockers are absolutely not useful, indeed they sometimes risk causing unpleasant side effects.
ROUTINE
This brings us, once again, to the need to calibrate therapy to the real needs of the individual patient. No to routine. In fact, it is unthinkable that all patients who have had a heart attack are treated in the same way regardless of the damage caused, the same drugs are superfluous and should not be prescribed.
* Professor of Cardiology Catholic University, Rome
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