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Associations between β-blocker therapy and cardiovascular outcomes in patients with diabetes and established cardiovascular disease.

Publication ,  Journal Article
Shavadia, JS; Zheng, Y; Green, JB; Armstrong, PW; Westerhout, CM; McGuire, DK; Cornel, JH; Holman, RR; Peterson, ED
Published in: Am Heart J
December 2019

BACKGROUND: The effects of β-blocker therapy in patients with type 2 diabetes (T2D) and established atherosclerotic cardiovascular disease (ASCVD) are unclear. We sought to evaluate associations between β-blocker use in T2D with ASCVD and cardiovascular (CV) outcomes. METHODS: In patients with T2D and ASCVD enrolled in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS), an inverse probability of treatment-weighted Cox proportional hazards model was used to examine the association between baseline β-blocker therapy (at randomization) and the primary CV composite (defined as CV death, non-fatal myocardial infarction [MI], non-fatal stroke, or hospitalization for unstable angina), including in subgroups with prior MI and heart failure (HF); other outcomes evaluated included individual components of the primary composite, hospitalization for HF, and severe hypoglycemic events. RESULTS: Of the 14,671 patients randomized, 9322 (64%) were on a β-blocker at baseline; these patients were more likely to have prior MI or HF. Over a median 3.0 (25th, 75th percentile: 2.2, 3.6) years, the risk of the primary CV composite was significantly higher with baseline β-blocker use versus no β-blocker use (4.5 vs. 3.4 events/100-patient years, adjusted hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.05-1.29); no significant interaction was noted for patients with versus without prior MI or HF. Baseline β-blocker use was not associated with risks for severe hypoglycemic events (HR 1.14, 95% CI 0.88-1.48). CONCLUSIONS: In this observational analysis of T2D and ASCVD, baseline β-blocker use was not associated with risks for severe hypoglycemia yet also was not associated with CV risk reduction over 3 years of follow-up, supporting a randomized examination of chronic β-blocker therapy in this patient population. (TECOS ClinicalTrials.gov number, NCT00790205).

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

December 2019

Volume

218

Start / End Page

92 / 99

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Stroke
  • Sitagliptin Phosphate
  • Proportional Hazards Models
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Hypoglycemic Agents
  • Hypoglycemia
 

Citation

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Chicago
ICMJE
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Shavadia, J. S., Zheng, Y., Green, J. B., Armstrong, P. W., Westerhout, C. M., McGuire, D. K., … Peterson, E. D. (2019). Associations between β-blocker therapy and cardiovascular outcomes in patients with diabetes and established cardiovascular disease. Am Heart J, 218, 92–99. https://doi.org/10.1016/j.ahj.2019.09.013
Shavadia, Jay S., Yinggan Zheng, Jennifer B. Green, Paul W. Armstrong, Cynthia M. Westerhout, Darren K. McGuire, Jan H. Cornel, Rury R. Holman, and Eric D. Peterson. “Associations between β-blocker therapy and cardiovascular outcomes in patients with diabetes and established cardiovascular disease.Am Heart J 218 (December 2019): 92–99. https://doi.org/10.1016/j.ahj.2019.09.013.
Shavadia JS, Zheng Y, Green JB, Armstrong PW, Westerhout CM, McGuire DK, et al. Associations between β-blocker therapy and cardiovascular outcomes in patients with diabetes and established cardiovascular disease. Am Heart J. 2019 Dec;218:92–9.
Shavadia, Jay S., et al. “Associations between β-blocker therapy and cardiovascular outcomes in patients with diabetes and established cardiovascular disease.Am Heart J, vol. 218, Dec. 2019, pp. 92–99. Pubmed, doi:10.1016/j.ahj.2019.09.013.
Shavadia JS, Zheng Y, Green JB, Armstrong PW, Westerhout CM, McGuire DK, Cornel JH, Holman RR, Peterson ED. Associations between β-blocker therapy and cardiovascular outcomes in patients with diabetes and established cardiovascular disease. Am Heart J. 2019 Dec;218:92–99.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

December 2019

Volume

218

Start / End Page

92 / 99

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Stroke
  • Sitagliptin Phosphate
  • Proportional Hazards Models
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Hypoglycemic Agents
  • Hypoglycemia