Common Heart Drug Proven Useless, Potentially Risky
- New research published August 30, 2024, reveals beta blockers offer no clinical benefit-and may even be harmful to women-following an uncomplicated heart attack with preserved heart function, potentially...
- For four decades, beta blockers have been a standard treatment for patients experiencing a myocardial infarction (heart attack) without meaningful complications and with preserved left ventricular ejection fraction...
- The REBOOT trial was a randomized, double-blind, placebo-controlled study involving 3,662 patients across 16 countries.
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Landmark REBOOT Trial Challenges 40-Year Standard of Care for Heart Attack Patients
New research published August 30, 2024, reveals beta blockers offer no clinical benefit-and may even be harmful to women-following an uncomplicated heart attack with preserved heart function, potentially reshaping global treatment guidelines.
What Happened: The REBOOT Trial Findings
For four decades, beta blockers have been a standard treatment for patients experiencing a myocardial infarction (heart attack) without meaningful complications and with preserved left ventricular ejection fraction (LVEF). however, the “REBOOT Trial,” led by Valentin Fuster, MD, PhD, of Mount Sinai Fuster Heart hospital and Spain’s Centro Nacional de Investigaciones Cardiovasculares (CNIC), challenges this long-held practice. results presented on August 30, 2024, at the European society of Cardiology Congress in Madrid, and simultaneously published in The New England Journal of Medicine, demonstrate no clinical benefit from beta blocker use in these patients. “Effect of beta-Blocker Therapy on Clinical Outcomes in Patients With a Myocardial Infarction and Preserved Ejection Fraction”.
The REBOOT trial was a randomized, double-blind, placebo-controlled study involving 3,662 patients across 16 countries. Patients were randomly assigned to receive either metoprolol succinate (a beta blocker) or placebo for one year. The primary outcome-a composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke-occurred in 4.7% of the beta-blocker group and 4.6% of the placebo group,demonstrating no statistically significant difference.American College of Cardiology News Release.
Further analysis revealed a concerning trend: a REBOOT substudy, published concurrently in the European Heart Journal, indicated that women treated with beta blockers experienced a higher risk of death, heart attack, or hospitalization for heart failure compared to women who did not receive the drug. This increased risk was not observed in men. “Sex-specific effects of beta-blocker therapy in patients with myocardial infarction and preserved ejection fraction: insights from the REBOOT trial”.
Why This Matters: Implications for Clinical Practice
The REBOOT trial’s findings have the potential to considerably alter clinical guidelines worldwide. For decades, beta blockers have been routinely prescribed post-heart attack, based on earlier research suggesting their protective effects. This new evidence suggests that, for a significant portion of heart attack patients-those with preserved LVEF-this practice may be needless and potentially harmful, especially for women.
“This trial will reshape all international clinical guidelines,” stated dr. Fuster. “It joins othre previous landmark trials led by CNIC and Mount Sinai-such as SECURE with the polypill and DapaTAVI, with SLT2 inhibition associated to TAVI-that have already transformed some global approaches to cardiovascular disease.”
The SECURE trial, published in The Lancet in 2023, demonstrated that a polypill containing aspirin, ramipril, and atorvastatin reduced cardiovascular events by 33% in patients after a heart attack.