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Beta-adrenergic blocking agent use and mortality in patients with asymptomatic and symptomatic left ventricular
D V Exner1, D L Dries, M A Waclawiw
1Clinical Trials Scientific Research Group, National Heart, Lung and Blood Institute, Bethesda, Maryland 20892, USA. ExnerD@gwgate.nhlbi.nih.gov
Insights
Beta-blocker use significantly reduced mortality in patients with left ventricular dysfunction. Combining beta-blockers with ACE inhibitors like enalapril further decreased the risk of death in the SOLVD Prevention trial.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Beta-blocker efficacy in asymptomatic left ventricular dysfunction is not well-established.
- The combined effect of beta-blockers and ACE inhibitors in these patients requires further investigation.
Purpose of the Study:
- To assess if beta-adrenergic blocking agents reduce mortality in the Studies of Left Ventricular Dysfunction (SOLVD).
- To determine if ACE inhibitor use modifies the association between beta-blockers and mortality.
Main Methods:
- Retrospective analysis of 4,223 SOLVD Prevention trial patients and 2,567 SOLVD Treatment trial patients.
- Evaluation of baseline beta-blocker use and its association with mortality.
Main Results:
- Beta-blocker use was linked to significantly lower mortality in both trials on univariate analysis.
- A synergistic reduction in mortality was observed with combined beta-blocker and enalapril use in the Prevention trial.
- Multivariate analysis confirmed reduced mortality with beta-blockers, especially when combined with enalapril, and lower rates of death or hospitalization for heart failure.
Conclusions:
- Combined use of beta-blockers and enalapril demonstrated a synergistic reduction in mortality risk within the SOLVD Prevention trial.
Objectives:
This analysis was performed to assess whether beta-adrenergic blocking agent use is associated with reduced mortality in the Studies of Left Ventricular Dysfunction (SOLVD) and to determine if this relationship is altered by angiotensin-converting enzyme (ACE) inhibitor use.
Background:
The ability of beta-blockers to alter mortality in patients with asymptomatic left ventricular dysfunction is not well defined. Furthermore, the effect of beta-blocker use, in addition to an ACE inhibitor, on these patients has not been fully addressed.
Methods:
This retrospective analysis evaluated the association of baseline beta-blocker use with mortality in 4,223 mostly asymptomatic Prevention trial patients, and 2,567 symptomatic Treatment trial patients.
Results:
The 1,015 (24%) Prevention trial patients and 197 (8%) Treatment trial patients receiving beta-blockers had fewer symptoms, higher ejection fractions and different use of medications than patients not receiving beta-blockers. On univariate analysis, beta-blocker use was associated with significantly lower mortality than nonuse in both trials. Moreover, a synergistic reduction in mortality with use of both a beta-blocker and enalapril was suggested in the Prevention trial. After adjusting for important prognostic variables with Cox multivariate analysis, the association of beta-adrenergic blocking agent use with reduced mortality remained significant for Prevention trial patients receiving enalapril. Lower rates of arrhythmic and pump failure death and risk of death or hospitalization for heart failure were observed.
Conclusions:
The combination of a beta-blocker and enalapril was associated with a synergistic reduction in the risk of death in the SOLVD Prevention trial.