Common heart medicine found ineffective in major study — could it change 40 year old treatment?

In India, the medicine ‘beta blockers’ has been a primary drug used for heart-related conditions and occupies roughly 16 percent of the anti-hypertensive medicine drug market in the country. One could easily recognise these pills with their unique suffix that ends with a ‘lol’.

A common medicine given to patients after a heart attack has been found ineffective by a major study — experts said this could change the course of a treatment which is as old as 40 years.

One could easily recognise these pills with their unique suffix that ends with a ‘lol’.

In India, the medicine ‘beta blockers’ has been a primary drug used for heart-related conditions and occupies roughly 16 percent of the anti-hypertensive medicine drug market in the country.

The findings could persuade doctors in India to look at the efficacy of the drug and whether it has any viable benefits for the patient.

As per the study done by the Mount Sinai School of Medicine (New York), these medicines are routinely prescribed after an uncomplicated heart attack.

Also, the study discovered that unnecessary putting women on beta blockers faced a higher risk of death, a repeated heart attack and hospitalisation for heart failure.

What are beta blockers?

Beta receptors are proteins on the surface of the cells lining near all organs- heart, lungs, walls of blood vessels, kidneys, brain and others.

These receptors interact with the stress hormones like epinephrine or adrenaline and often get triggered by them. 

When the stress hormones activate these beta receptors around the heart or blood vessels, this causes the muscles of the heart or blood vessels to become excited and increase blood flow through them. It results in an increased heart rate or increased blood pressure.

A person is said to have a heart attack when a fatty plaque bursts inside the blood vessel, leading to clot formation and blocking the flow of blood inside it.

Earlier, in the absence of techniques like angioplasty (a minimally invasive procedure used to open a narrowed or blocked artery and then later placing a stent preventing the walls from a collapse), the affected person had to stay with an obstructed blood vessel for longer periods and also the muscle damage was significant. 

So, this is when beta blockers became a routine prescription, preventing the heart from getting excitable and slowing its rate for the muscles to heal.

Beta blockers prevent the beta receptors from binding with the stress hormones, said the Harvard Health Publishing.

Among the common brands prescribed in India are — Metoprolol, Bisoprolol, Atenolol, Carvedilol and others.

What did the study find?

The findings came from the REBOOT trial, a large international study based in Spain and Italy and the results have been published in the The New England Journal of Medicine. 

The researchers had enrolled about 8,505 patients from 109 hospitals in Spain and Italy. The participants were randomly assigned to receive beta blockers or to avoid them alongside the standard post heart attack care which remained the same for all.

All of them were observed for changes in the next four years following their discharge from the hospital.

The investigators found that beta blockers did not significantly reduce risk of repeated heart attack, reduce death or prevent hospitalisation in patients whose heart function was normal after the first attack.

The findings raised concern on the utility of a drug which had no apparent benefits for patients with uncomplicated heart attacks.

However, the medicine was found to be useful in those in whom the damage following the heart attack was significant.

As per experts, removing an ineffective drug from the standard care could simplify the treatment and cut down the side effects associated with the drug.

Women at greater risk

As per the study, there was a sex-specific risk associated with beta blockers. 

According to researchers, women prescribed a beta blocker after a cardiac event had a 2.7 percent higher risk of death during the follow-up years as compared to women who were asked to avoid beta blockers.