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[Effects of beta blockers on lipoprotein metabolism]
M M Ritter1, W O Richter, P Schwandt
1Medizinische Klinik II, Universität München.
Insights
Beta blockers can negatively impact lipid metabolism, affecting triglyceride and HDL cholesterol levels. Monitoring is recommended, with potential adjustments to treatment, especially for patients with hyperlipoproteinemia.
Area of Science:
- Cardiology
- Pharmacology
- Biochemistry
Context:
- Hypertension treatment has historically disappointed in preventing coronary heart disease mortality.
- Antihypertensive medications may adversely affect lipid metabolism, contributing to treatment limitations.
Purpose:
- To differentiate the effects of various beta blockers on lipid metabolism.
- To inform clinical practice regarding lipid monitoring during beta blocker therapy.
Summary:
- Beta blockers without intrinsic sympathomimetic activity (ISA) significantly increase triglycerides and decrease HDL cholesterol.
- Beta-1 selective blockers show a smaller increase in triglycerides, while those with ISA are largely neutral.
- Individual patient responses, especially with hyperlipoproteinemia, can be unpredictable.
Impact:
- Lipoprotein monitoring is crucial during beta blocker treatment.
- Switching antihypertensive agents may be necessary if adverse lipid changes occur.
- Despite lipid side effects, beta blockers without ISA are vital for secondary myocardial infarction prevention due to proven mortality reduction.
Problem:
With respect to prevention of its most common complication--mortality from coronary heart disease--treatment of hypertension had disappointed. It is possible that this is due to negative effects of antihypertensives on lipid metabolism.
Major Topics:
The effects of beta blockers on lipid metabolism can be differentiated principally, in accordance with the classification of beta blockers into those with and those without intrinsic sympathomimetic activity (ISA), as also selectivity and non-selectivity. Thus, non-selective beta blockers with no ISA usually lead to an increase in triglycerides of 25% to 30%, and a decrease in HDL cholesterol of about 15%. On average, beta-1 selective blockers result in a smaller increase in triglycerides. Beta blockers with ISA, in contrast, are largely neutral vis-à-vis lipid metabolism. In the individual case, in particular in the presence of hyperlipoproteinemia, the effects cannot be reliably predicted.
Conclusions:
Lipoprotein concentrations should be monitored during treatment with beta blockers. If necessary, a change in the agent employed is recommended. In the case of prevention of a second myocardial infarction, for which various studies have unequivocally shown a reduction in mortality associated with treatment with beta blockers with no ISA, these side effects will, however, be accepted--with the exception of extreme changes--for a limited period of time.