β-Blockers and Progression of Coronary Atherosclerosis: Pooled Analysis of 4 Intravascular Ultrasonography Trials

Sipahi, İlke; Tuzcu, E. Murat; Wolski, Katherine E.; Nicholls, Stephen J.; Schoenhagen, Paul; Hu, Bo; Shishehbor, Mehdi H.; Magyar, William A.; Crowe, Tim; Kapadia, Samir; Nissen, Steven E.

doi:10.7326/0003-4819-147-1-200707030-00003

Cited by 88 publications

(46 citation statements)

References 32 publications

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“…[17][18][19] The course of these effects may require weeks to develop, which could partially explain the superior nature of chronic ␤ blockade in our study. A further explanation may be that patients with chronic ␤-blocker therapy underwent a de facto titration process.…”

Section: Discussionmentioning

confidence: 92%

Chronic β Blockade Is Associated with a Better Outcome after Elective Noncardiac Surgery than Acute β Blockade

2011

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Background: Current guidelines on perioperative care recommend the prophylactic use of ␤ blockers in high-risk patients undergoing noncardiac surgery. However, recent studies show that, in some instances, perioperative ␤ blockade can cause harm. Furthermore, chronic ␤ blockade, titrated to effect before surgery, may be superior to acute perioperative ␤ blockade. The primary objective of this study was to compare major acute cardiac outcomes in patients who underwent surgery with chronic ␤ blocker therapy with those in patients with acute ␤-blocker therapy. Methods: Data were collected for 10,691 consecutive patients undergoing elective noncardiac surgery between April 1, 2008, and April 30, 2010. Propensity scores, estimating the probability of receiving a preoperative ␤ blocker, were calculated to match (1:1) the patients with acute and chronic ␤-blocker therapy. The primary outcome was a composite of myocardial infarction, nonfatal cardiac arrest, and perioperative mortality. The rate of cardiac events was compared in the matched cohorts. Results: A total of 962 patients were chronically treated with a ␤ blocker before surgery; in 436 patients, the ␤ blocker was administrated acutely. Propensity score matching created 301 patient pairs who were well-balanced for major comorbidities, concomitant drug use, and type of surgery. The primary outcome was observed in 9 (3.0%) chronic versus 24 (8.0%) acute ␤-blocked patients (relative risk, 2.67; 95% CI, 1.27-5.60; P ϭ 0.011).

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Section: Discussionmentioning

confidence: 92%

Chronic β Blockade Is Associated with a Better Outcome after Elective Noncardiac Surgery than Acute β Blockade

2011

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“…Probably not, as witnessed by the excellent performance of atenolol in the UKPDS study, in spite of increases in plasma Hb A1-c (Figure 4) [65,67]. Undoubtedly important in the good long-term results with beta-blockers in young/middle-aged hypertensive subjects (at least in the non-smokers) is the fact that they have been shown to regress the coronary atheromataous process in middle-aged subjects and to stabilise the unstable coronary plaque [41,53,85].…”

Section: Diureticsmentioning

confidence: 99%

The Unholy Alliance between Obesity, Type-2 Diabetes, the Sympathetic Nervous System, and Hypertension in Young/Middle-Aged Subjects

Cruickshank¹

2014

J Mol Genet Med

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“…Учитывая современные представления о механизмах патогенеза периопе-рационного ИМ [43][44][45][46][47][48], ББ представляются пато-физиологически обоснованными для его профи-лактики. Краткосрочное их действие сводится к подавлению стрессорных реакций сердечно-сосу-дистой системы, а их отдаленные эффекты могут быть связаны со снижением уровня медиаторов вос-паления и стабилизацией атеросклеротических бля-шек в коронарных артериях [49][50][51]. Хотя, несом-ненно, для достижения прежнего класса I доказанно-сти этого положения требуется проведение новых хорошо спланированных рандомизированных иссле-дований с обоснованным выбором конкретного пре-парата, соблюдением режима дозирования и сроков терапии, титрацией дозы ББ, строгим контролем целевой ЧСС и АД и жесткими конечными точками.…”

Section: Efficacy and Safety Of Beta-adrenoblocker Treatment During Punclassified

Efficacy and Safety of Beta-Adrenoblocker Treatment During Postoperational Period After Extracardial Surgery - A Paradigm Shift?

Щукин¹,

Суркова²,

Хохлунов³

et al. 2014

Russ J Cardiol

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Долгое время бета-блокаторы (ББ) были бесспорно лидирующим классом препаратов, назначаемых с целью профилактики инфаркта миокарда (ИМ) и сердечно-сосудистой смертности в интра-и раннем послеоперационном периодах внесердечных хирургических вмешательств. Однако в последние годы результаты наиболее крупных исследований семейства DECREASE, ука-зывающие на положительное влияние ББ в плане снижения частоты развития периоперационного инфаркта миокарда, были дискредитированы. В обзоре обсуждаются современные представления о патогенезе периопераци-онного инфаркта миокарда, анализируются работы, в которых изучались различ-ные аспекты применения ББ в периоперационном периоде. Показано, что их краткосрочное действие сводится к подавлению стрессовых реакций сердечно-сосудистой системы, а отдаленные эффекты связаны со снижением уровня медиаторов воспаления, что приводит к стабилизации атеросклеротических бляшек в коронарных артериях, уменьшению их объема. Вместе с тем, на сегод-няшний день мы не располагаем убедительными данными относительно пользы и рисков периоперацинной терапии ББ, и вопрос об эффективности и безопасно-сти назначения ББ при выполнении внесердечных хирургических вмешательств остается открытым. Для ответа на него требуется проведение новых хорошо спланированных рандомизированных исследований с обоснованным выбором конкретного препарата, соблюдением режима дозирования и сроков терапии, титрацией дозы ББ, строгим контролем целевой частоты сердечных сокращений и артериального давления и жесткими конечными точками. Российский кардиологический журнал 2014, 9 (113): 11-15Ключевые слова: бета-блокаторы, предоперационный период, инфаркт мио-карда. EFFICACY AND SAFETY OF BETA-ADRENOBLOCKER TREATMENT DURING POSTOPERATIONAL PERIOD AFTER EXTRACARDIAL SURGERY -A PARADIGM SHIFT?Shchukin Yu. V. For a long time beta-blockers (BB) have been sure the leading drug class to prescribe with preventive aims for myocardial infarction MI or cardiovascular morbidity in intra-and early postoperational periods of extracardial surgical interventions. However during last years the results of the most salient trials of the DECREASE family, showing positive effects of BB on decrease of intraoperational MI, were discredited. The review concerns on contemporary thought on pathogenesis of perioperational MI; the studies are analyzed which have explored various aspects of BB use in perioperational period. It is shown that their short-term action is mostly supress of stress reactions of cardiovascular system, and long-term effects are decrease of inflammatory mediators levels; this leads to atherosclerotic plaques stabilization and their volume decrease. Also we do not have good enough data on benefits or lack of perioperationsl therapy by BB, and the problem of the safety and efficacy of BB use is still open. To answer this more trials needed with perfectly formulated targets and thoroughly worked out design, choice of drug, compliant dosing regimen, dose titration, strict control of target heartrate and plodd pressure, and strict endpoints.R...

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β-Blockers and Progression of Coronary Atherosclerosis: Pooled Analysis of 4 Intravascular Ultrasonography Trials

Abstract: The analysis demonstrates that beta-blockers can slow progression of coronary atherosclerosis. The findings provide additional support for the current clinical guidelines advocating long-term use of beta-blockers to treat most forms of coronary artery disease.

Cited by 88 publications

References 32 publications

Chronic β Blockade Is Associated with a Better Outcome after Elective Noncardiac Surgery than Acute β Blockade

Chronic β Blockade Is Associated with a Better Outcome after Elective Noncardiac Surgery than Acute β Blockade

The Unholy Alliance between Obesity, Type-2 Diabetes, the Sympathetic Nervous System, and Hypertension in Young/Middle-Aged Subjects

Efficacy and Safety of Beta-Adrenoblocker Treatment During Postoperational Period After Extracardial Surgery - A Paradigm Shift?

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