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Effect of beta blockers on incidence of new coronary events in older persons with prior myocardial infarction and symptomatic peripheral arterial disease

2001; Elsevier BV; Volume: 87; Issue: 11 Linguagem: Inglês

10.1016/s0002-9149(01)01521-1

1879-1913

Wilbert S. Aronow, Chul Ahn,

Acute Myocardial Infarction Research

Beta blockers reduce the incidence of new coronary events in older patients after myocardial infarction. 1 Gundersen T. Abrahamsen A.M. Kjekshus J. Ronnevik P.K. Norwegian Multicentre Study GroupTimolol-related reduction in mortality and reinfarction in patients ages 65–75 years surviving acute myocardial infarction. Circulation. 1982; 66: 1179-1184 Crossref PubMed Scopus (129) Google Scholar , 2 Hawkins C.M. Richardson D.W. Vokonas P.S. Effect of propranolol in reducing mortality in older myocardial infarction patients the Beta-Blocker Heart Attack Trial experience. Circulation. 1983; 67: I-194-I-197 Google Scholar , 3 Hjalmarson A. Elmfeldt D.T. Herlitz J. Holmberg S. Malek J. Nyberg G. Ryden L. Swedberg K. Vedin A. Waagstein F. Waldenstrom A. Waldenstrom J. et al. Effect on mortality of metoprolol in acute myocardial infarction. Lancet. 1981; 2: 823-827 Abstract PubMed Scopus (887) Google Scholar , 4 Pedersen T.R. Norwegian Multicentre Study GroupSix-year follow-up of the Norwegian Multicentre Study on Timolol after acute myocardial infarction. N Engl J Med. 1985; 313: 1055-1058 Crossref PubMed Scopus (208) Google Scholar Patients with peripheral arterial disease (PAD) are at increased risk for developing coronary events. 5 Hertzer N.R. Beven E.G. Young J.R. O'Hara P.J. Ruschhaupt III, W.F Graor R.A. deWolfe V.G. Maljovec L.C. Coronary artery disease in peripheral vascular patients a classification of 1,000 coronary angiograms and results of surgical management. Ann Surg. 1984; 199: 223-233 Crossref PubMed Scopus (1191) Google Scholar , 6 Smith G.D. Shipley M.J. Rose G. Intermittent claudication, heart disease risk factors, and mortality the Whitehall study. Circulation. 1990; 82: 1925-1931 Crossref PubMed Scopus (379) Google Scholar , 7 Aronow W.S. Ahn C. Mercando A.D. Epstein S. Prognostic significance of silent ischemia in elderly patients with peripheral arterial disease with and without previous myocardial infarction. Am J Cardiol. 1992; 69: 137-139 Abstract Full Text PDF PubMed Scopus (44) Google Scholar , 8 Mautner G.C. Mautner S.L. Roberts W.C. Amounts of coronary arterial narrowing by atherosclerotic plaque at necropsy in patients with lower extremity amputation. Am J Cardiol. 1992; 70: 1147-1151 Abstract Full Text PDF PubMed Scopus (52) Google Scholar Many physicians have been reluctant to use β blockers in patients with PAD because of concerns that β blockers will aggravate intermittent claudication. However, a meta-analysis of 11 randomized controlled studies found that β blockers do not adversely affect walking capacity or the symptoms of intermittent claudication in patients with mild-to-moderate PAD. 9 Radack K. Deck C. Beta-adrenergic blocker therapy does not worsen intermittent claudication in subjects with peripheral arterial disease meta-analysis of randomized controlled trials. Arch Intern Med. 1991; 151: 1769-1776 Crossref PubMed Scopus (334) Google Scholar We report data from an observational study investigating the effect of β blockers on the incidence of new coronary events in older patients with symptomatic PAD and prior myocardial infarction.