Related Experiment Video

Updated: Jul 19, 2025

Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs

Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs

Published on: April 17, 2021

Effect of Beta-Blocker on Long-Term Major Cardiovascular Events in High Atherosclerotic Risk Population

Nichanan Osataphan¹, Kamol Udol², Khanchai Siriwattana³

¹Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.

Cardiovascular Drugs and Therapy

|August 18, 2023

Insights

Beta-blockers may increase the risk of major adverse cardiovascular events (MACEs) in high-risk patients without coronary artery disease. Caution is advised when prescribing beta-blockers without clear indications for cardiovascular patients.

Area of Science:

Cardiology
Clinical Pharmacology

Background:

Beta-blockers are widely used for cardiovascular diseases.
Their long-term benefit in patients with preserved left ventricular ejection function (LVEF) on major adverse cardiovascular events (MACEs) remains uncertain.

Purpose of the Study:

To investigate the effect of beta-blocker use on MACEs in patients with high atherosclerotic risk and preserved LVEF.

Main Methods:

Prospective study (CORE-Thailand) of Thai patients with high atherosclerotic risk.
Follow-up for 5 years, excluding patients with LVEF < 50%.
Primary outcome: MACEs (all-cause death, myocardial infarction, stroke). Propensity score matching used for analysis.

Main Results:

Beta-blocker use was associated with a higher risk of 3P-MACEs (adjusted HR 1.29).
Consistent results observed after propensity score matching (adjusted HR 1.29).
In patients with coronary artery disease (CAD), beta-blockers did not increase MACEs, but in those without CAD, risk increased (adjusted HR 1.51).

Conclusions:

Beta-blocker therapy is linked to an increased risk of MACEs in high-risk patients with preserved LVEF.
Prescribing beta-blockers requires careful consideration, especially in patients without a clear indication like CAD.

Read full analysis

Abstract

Purpose:

Beta-blocker is a frequently used medication in cardiovascular diseases. However, long-term benefit of beta-blocker in patients with preserved left ventricular ejection function (LVEF) on major adverse cardiovascular events (MACEs) is uncertain.

Methods:

The Cohort Of patients with high Risk for cardiovascular Events (CORE-Thailand) was a prospective study that enrolled Thai patients with high atherosclerotic risk including multiple atherosclerotic risk factors and established atherosclerotic cardiovascular diseases. Baseline demographic data, co-morbidities and medication were recorded. Patients were followed for 5 years. Patients with LVEF<50% were excluded. Primary outcome was the effect of beta-blocker on the occurrence of MACEs including all-cause death, non-fatal myocardial infarction and non-fatal stroke (3P-MACEs). Propensity score matching was used to control confounding factors.

Results:

There was a total of 8513 patients in the pre-matched cohort, 4418 were taking beta-blocker and 4095 were not. After adjustment of confounders, beta-blocker was an independent predictor of 3P-MACEs (adjusted HR 1.29;95% CI 1.12-1.49;p<0.001). After propensity score matching, 4686 patients remained in the post-matched cohort. Propensity score analysis showed consistent results in which patient taking beta-blocker had higher risk of 3P-MACEs (adjusted HR 1.29;95% CI 1.10-1.53;p=0.002). Subgroup analysis in patients with coronary artery disease (CAD) indicated that taking beta-blocker did not increase the incidence of 3P-MACEs (adjusted HR 0.99;95% CI 0.76-1.29) while those without CAD did (adjusted HR 1.51; 95% CI, 1.22-1.86;p-interaction=0.015).

Conclusion:

In patients with high atherosclerotic cardiovascular risk, taking beta-blockers had a higher risk of 3P-MACEs. Care should be taken when prescribing beta-blockers to patients without a clear indication.

Trial Registration:

TCTR20130520001 registered in Thai Clinical Trials Registry (TCTR) https://www.thaiclinicaltrials.org/ , date of registration 20 May 2013.

Keywords:

Atherosclerosis Beta-blocker Cardiovascular risk factors Coronary artery disease Peripheral artery disease Stroke

More Related Videos

Quantitative Analysis of Cellular Composition in Advanced Atherosclerotic Lesions of Smooth Muscle Cell Lineage-Tracing Mice

Quantitative Analysis of Cellular Composition in Advanced Atherosclerotic Lesions of Smooth Muscle Cell Lineage-Tracing Mice

Published on: February 20, 2019

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

Related Concept Videos

Heart Failure Drugs: β-Blockers

Heart Failure Drugs: β-Blockers

β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation,...

Adrenergic Antagonists: Pharmacological Actions of β-Receptor Blockers

Adrenergic Antagonists: Pharmacological Actions of β-Receptor Blockers

β-receptor blockers significantly impact the cardiovascular system by counteracting catecholamine-induced sympathetic responses. These medications decrease heart rate, contractility, and cardiac output, potentially leading to cardiac depression, life-threatening bradycardia, and death. Therapeutically, β-blockers function as mild antihypertensives and are utilized in treating angina pectoris and cardiac arrhythmias. However, nonselective β-blockers inhibit β2-receptors in...

Antihypertensive Drugs: Types of β-Blockers

Antihypertensive Drugs: Types of β-Blockers

β receptors are classified into three subclasses: β1, β2, and β3. β1 receptors are primarily located in the heart and kidneys. When they get activated, they increase heart rate, contractility, and renin release. This process enhances blood pressure and aids in stress management. In contrast, β2 receptors are situated mainly in the lungs, blood vessels, and skeletal muscles. Upon activation, they trigger smooth muscle relaxation, causing bronchodilation and...

Adrenergic Antagonists: ɑ and β-Receptor Blockers

Adrenergic Antagonists: ɑ and β-Receptor Blockers

Third-generation β-blockers, such as labetalol and carvedilol, represent a significant advancement in managing cardiovascular conditions. Unlike conventional β-blockers, which can induce peripheral vasoconstriction, third-generation drugs block α1 adrenoceptors. This promotes vasodilation through several mechanisms, such as increased nitric oxide production, inhibition of calcium ion entry, opening of potassium ion channels, and antioxidant action. Labetalol, for instance, is...

Antihypertensive Drugs: Action of β1 Blockers

Antihypertensive Drugs: Action of β₁ Blockers

β1-receptors are primarily located in the heart and kidneys. In cardiac myocytes, these receptors interact with neurotransmitters released by the sympathetic nervous system during heightened activity or danger. As a result, β1-receptors get activated, initiating a series of biochemical processes. Excessive activation of beta receptors due to chronic stress can abnormally increase heart rate and contractility, resulting in high blood pressure or hypertension. To counteract this,...

Adrenergic Antagonists: Chemistry and Classification of β-Receptor Blockers

Adrenergic Antagonists: Chemistry and Classification of β-Receptor Blockers

β-adrenergic antagonists, or β-blockers, modulate the sympathetic nervous system by targeting β-adrenoceptors and inhibiting catecholamine-mediated sympathetic responses. β-blockers differ in their adrenoceptor subtype affinity, lipophilicity, and α-blocking capabilities. The history of β-blocker development began with the prototype, dichloroisoprenaline, which exhibited partial agonist activity. As a result, propranolol was developed as a pure antagonist but...

Articles linked to this work by shared authors, journal, and citation graph.

Influence of Continuous Predictor Modelling Methods on Prediction Stability in Clinical Prediction Model Development: An Empirical Comparison Using Real Clinical Data.

Clinical epidemiology·2026

Family Experiences of the Strong Families Program in Thailand: Prospective Mixed Methods Cohort Study.

JMIR pediatrics and parenting·2026

Comparison of Fixed and Age-Sex-Adjusted NFPA Standards for Cardiopulmonary Fitness in Thai Wildland Firefighters.

Journal of occupational and environmental medicine·2026

Predictors of echocardiographic abnormalities in asymptomatic individuals with increased cardiothoracic ratio detected on chest radiography.

American heart journal plus : cardiology research and practice·2026

Evaluating the role of indoor environmental quality in predicting ocular and general sick building syndrome: insights from the AIRMED project.

PeerJ·2026

Kidney Function-Specific Performance of High-Sensitivity Troponin T and I Using 0/1 h and 0/3 h Protocols in Suspected Non-ST-Segment Elevation Acute Coronary Syndrome.

Biomedicines·2026

See all related articles