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β-Blockers and Progression of Coronary Atherosclerosis
IN RESPONSE:
Dr. Dunaway's statement that “[p]rospective studies have shown no decreased incidence of myocardial infarction (MI) and stroke in patients treated with β-blockers versus placebo” is not true. The meta-analyses by Lindholm and colleagues (1) and Bradley and colleagues (2), involving more than 20 000 patients with hypertension, showed that β-blockers statistically significantly reduced the incidence of stroke by 19% compared with placebo (95% CI for relative risk, 0.71 to 0.93). Although a non–statistically significant reduction in incidence of MI occurred in these meta-analyses (CI for relative risk, 0.83 to 1.05), β-blockers statistically significantly reduced the incidence of MI by 28% to 41% in patients with a history of MI (3, 4). Recently, it has been recommended that β-blockers not be preferred over other antihypertensives as first-line agents in primary prevention. However, we stated that “ … our analysis involved only patients with established coronary artery disease. Therefore, no conclusion about the effects of β-blocker use can be drawn for primary prevention (for example, hypertensive patients without coronary artery disease).” This statement limits the implications of our study to secondary prevention.
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Potential Financial Conflicts of Interest: Dr. Sipahi has received an educational grant from Pfizer and lecture honoraria from AstraZeneca. Dr. Nissen has received research support from AstraZeneca, Eli Lilly, Pfizer, Takeda, Sankyo, and Sanofi-Aventis. Dr. Sipahi has also consulted for many pharmaceutical companies without financial compensation. All honoraria, consulting fees, or other payments from any for-profit entity are paid directly to charity so that no income or tax deduction is received.
