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Diabetes Care 29:483 2006
DOI: 10.2337/diacare.29.02.06.dc05-1830
© 2006 by the American Diabetes Association
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Letters: Comments and Responses

The Effectiveness of ß-Blockers After Myocardial Infarction in Patients With Type 2 Diabetes

Response to McDonald et al.

David S.H. Bell, MB, FACE

University of Alabama at Birmingham, Birmingham, Alabama

Address correspondence to David S. H. Bell, MB, FACE, Faculty Office Tower, Room 754, 510 South 20th St., Birmingham, AL 35294. E-mail: dshbell{at}uab.edu

In the September 2005 issue of Diabetes Care, McDonald et al. (1) showed that ß-blocker therapy after myocardial infarction (MI) was not associated with reduced mortality or fewer recurrent events in people with type 2 diabetes in routine practice. This contrasted with studies performed before intervention with drugs such as ACE inhibitors and statins were available. These studies showed a significant decrease in mortality and reinfarction post-MI in diabetic subjects (2, 3). The authors conclude that the benefits of ß-blockers are attenuated in the era of multiple interventions.

I believe that there is another reason for the decreased effectiveness of ß-blockers in the modern era. When the older studies were preformed, the majority of ß-blockers used were nonselective ß-blockers that blocked both the ß1 and the ß2 receptors. Selective ß1 blockers, unless used intravenously at the time of the MI, have never been shown to decrease reinfarction or mortality post-MI (4). In contrast, nonselective ß-blockers (propranolol and pindolol) with normal ventricular function, as well as carvedilol with decreased ventricular function, have been shown to decrease cardiac events and mortality post-MI.

Therefore, I believe that the shift in effectiveness of ß-blockers post-MI is not due to multiple other interventions but to utilization of ß1-blockers, which—especially at lower doses—have not been shown to decrease mortality or reinfarction. A reanalysis based on the use of ß1 selective and nonselective ß-blockers could prove or disprove this theory.

Footnotes

D.S.H.B. has received honoraria from GlaxoSmithKline, Bristol-Myers Squibb, and Aventis.

References

  1. McDonald CG, Majumdar SR, Mahon JL, Johnson JA: The effectiveness of ß-blockers after myocardial infarction in patients with type 2 diabetes. Diabetes Care 28:2113–2117, 2005[Abstract/Free Full Text]
  2. Kjekshus J, Gilpin E, Cali G, Blackey AR, Henning H, Ross J Jr.: Diabetic patients and beta-blockers after acute myocardial infarction. Eur Heart J 11:43–50, 1990[Abstract/Free Full Text]
  3. Jonas M, Reicher-Reiss H, Boyko V, Shotan A, Mandelzweig L, Goldbourt U, Behar S: Usefulness of beta-blocker therapy in patients with non-insulin dependent diabetes mellitus and coronary artery disease: Bezafibrate Infarction Prevention (BIP) Study Group. Am J Cardiol 77:1273–1277, 1996[Medline]
  4. Freemantle N, Cleland J, Young P, Mason J, Harrison J: Beta blockade after myocardial infarction: systematic review and meta regression analysis. BMJ 18:1730–1737, 1999

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This Article
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