Préccri for more than 40 years after a heart attack, beta -blockers are considered to be a reference treatment. They are also used to deal with other heart diseases. But an important international study, published in the New England Journal of Medicine And presented at the Congress of the European Cardiology Society in Madrid, challenges their use, in this context. Especially in women whose heart function is preserved, after a myocardial infarction.
A study that studies patients without a sign of severe heart failure
The data from this study comes from the reboot test, which followed 8,505 men and women victims of a myocardial infarction, in 109 hospitals in Spain and Italy, for almost four years. None of the participants had a left ventricular ejection fraction of less than 40 %, a sign of severe heart failure.
The patients were divided into two groups: one treaty by beta -blockers, the other not. All have benefited from modern classic treatments, including stents and anticoagulants, as soon as they are admitted.
An increase in the risk of death in women
Result : “Among the patients who left the hospital after invasive care for a myocardial infarction with a left ventricular ejection fraction greater than 40 %, treatment with beta-blocker did not seem to have an effect on the incidence of deaths all causes, recurrences of infarction or hospitalization for heart failure “ write the researchers.
In addition, a distinct meta-analysis published in The Lancet has shown a profit for patients with an ejection fraction between 40 and 50 %.
But this effect is not verified in women whose heart function remained normal after their infarction (ejection fraction greater than 50 %).
For them, the risk of serious events increased under beta -blockers, according to another study published in theEuropean Heart Journal. They were significantly more likely to have a new heart attack, to be hospitalized for heart failure and almost three times more likely to die than those who did not take it.
“”It was particularly true for women receiving high doses of beta -blockers“Said Dr. Borja Ibáñez, scientific director of the National Cardiovascular Investigation Center in Madrid and the main author of this Lancet study.
Why a difference according to sex?
“”It’s actually not surprising“Reacted Dr. Andrew Freeman, director of cardiovascular prevention at the National Jewish Health in Denver, interviewed by Cnn.
“Sex is linked with the way people react to drugs. In many cases, women have a smaller heart. They are more sensitive to hypertension drugs. This effect can be linked to the size of the heart or other factors that we have not yet fully understood.”
Be that as it may, these studies already arouse reactions in the world of cardiology.
For Dr. Valentin Fuster, president of Mount Sinai Hospital in New York, “These results will reshape all international clinical guidelines on the use of beta -blockers in men and women and should trigger a specific sex approach for a long time for the treatment of cardiovascular diseases“.
Other studies are necessary to decide, according to a cardiologist
An opinion clearly nuanced by Dr Olivier Hoffmann, cardiologist and member of the foundation’s administration committee Act for the hearts of women. Asked about these results, he was careful.
“What emerges is the fact that beta -blockers are beneficial, only if the ejection fraction of the heart is less than 50%. When the ejection fraction is normal, therefore that the left ventricle works normally, the beta -blockers seem pejorative, in women, therefore clearly not recommended, because they would increase mortality, which seems surprising”.
Before continuing: “These drugs have known undesirable effects, such as the drop in blood pressure, for example, it is undeniable. But not to the point of considering them as pejorative, for women. It is difficult to draw clear conclusions from these contradictory results “.
For the expert, other randomized double -blind studies must still support these first results. “”This may ultimately be confirmed, develop prescription protocols for cardiologists “.