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Published on: December 7, 2016
Effect of β-blocker therapy in diabetic patients with stable coronary heart disease: a meta-analysis
Aaqib H Malik1, Suchith Shetty2, Kausik Kar1
1Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA.
Insights
Beta-blocker therapy in diabetic patients with stable coronary heart disease may increase cardiovascular mortality and major adverse cardiovascular events. Further research is needed to confirm these findings in this patient group.
Area of Science:
- Cardiology
- Diabetology
- Pharmacology
Background:
- Beta-blocker (BB) therapy is a standard treatment for coronary heart disease (CHD).
- Limited evidence exists on the long-term benefits of BB therapy for diabetic patients with stable CHD.
- This meta-analysis investigates the efficacy and safety of BB therapy in this specific population.
Purpose of the Study:
- To summarize the current evidence on beta-blocker therapy in diabetic patients with stable coronary heart disease.
- To evaluate the association between beta-blocker therapy and mortality and major adverse cardiovascular events in this cohort.
Main Methods:
- A systematic meta-analysis was conducted following PRISMA and MOOSE guidelines.
- Searches were performed in PubMed, Embase, and Cochrane Central databases.
- Four non-randomized studies with 9515 participants were included, assessing all-cause mortality, cardiovascular mortality, and MACE.
Main Results:
- Beta-blocker therapy was associated with a 27% increased risk of cardiovascular mortality and a 32% increased risk of MACE in diabetic patients with stable CHD (P < 0.05).
- No significant reduction in all-cause mortality was observed (HR 1.12; P = 0.22).
- The findings were based on four non-randomized studies, including post-hoc analyses and survey data.
Conclusions:
- Beta-blocker therapy in diabetic patients with stable CHD may be associated with increased mortality.
- Larger randomized controlled trials are essential to validate these findings and guide clinical practice.
Background:
β-blocker (BB) therapy is a cornerstone for the treatment of coronary heart disease (CHD). The evidence of the benefit from long-term BB therapy in diabetic patients with stable CHD is scarce. This meta-analysis summarizes the evidence relating to the BB therapy in diabetic patients with stable CHD.
Methods:
A meta-analysis was performed according to PRISMA and MOOSE guidelines for reporting of systematic reviews of observational studies. PubMed, Embase, and Cochrane central were searched and two authors independently screened studies for eligibility. The quality of studies was assessed with the Newcastle Ottawa scale. The primary outcome of interest was all-cause mortality, cardiovascular (CV) mortality and major adverse cardiovascular events (MACE) in diabetic patients with and without BB therapy. A generic inverse variance model was used to pool odds ratio or hazards ratio from included studies to calculate the overall effect estimate. The significance threshold was set at P-value < 0.05. Heterogeneity was assessed by I 2.
Results:
Four non-randomized studies with 9515 participants were selected for the analyses. Four studies were post-hoc analyses of randomized controlled trials, and one article was an analysis of a nationally representative survey. In a fixed effects model, BB therapy in diabetic patients with stable CHD was found to be associated with increased risk of CV mortality, and MACE (27% and 32% respectively; P-value < 0.05) and was not associated with a reduction in all-cause mortality (HR 1.12; 95% CI: 0.94-1.33; P-value = 0.22).
Conclusion:
BB therapy in diabetic patients with stable CHD appears to be linked to higher mortality. Large randomized trials are needed in this population to confirm these findings.
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