Associations between ?-blocker therapy and cardiovascular outcomes in patients with diabetes and established cardiovascular disease - 02/12/19
, Yinggan Zheng, MA, Med c, Jennifer B. Green, MD a, Paul W. Armstrong, MD c, Cynthia M. Westerhout, PhD c, Darren K. McGuire, MD, MHSc d, Jan H. Cornel, MD e, Rury R. Holman, MB, ChB f, Eric D. Peterson, MD, MPH aAbstract |
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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| Matthew Aaron Cavender, MD, MPH, served as guest editor for this article. |
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| Acknowledgments: Peter Hoffmann, an employee of the Duke Clinical Research Institute, provided editorial support. |
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| Disclosures: Dr Shavadia: None. Mr Zheng: None. Dr Green: has received grants from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline and Sanofi, and personal fees from AstraZeneca, Merck, Boehringer-Ingelheim, Sanofi/Regeneron, and NovoNordisk. Dr Armstrong: has received research grants, personal fees and non-financial support from Merck; complete disclosure available at Financial-Disclosure-form-PWA-September2018-Final.pdf. Dr Westerhout: None. Dr McGuire: has provided clinical trial leadership for AstraZeneca, Sanofi Aventis, Janssen, Boehringer Ingelheim, Merck & Co, Novo Nordisk, Lexicon, Eisai, GlaxoSmithKline, and Esperion, and consultancy for AstraZeneca, Sanofi Aventis, Lilly US, Boehringer Ingelheim, Merck & Co, Pfizer, Novo Nordisk, Applied Therapeutics, and Metavant. Dr Cornel: has received grants from ZonMw, WSN, Dutch Heart foundation and has consultancy associations with Merck, AstraZeneca, Novartis, Sanofi, Amgen. Dr Holman: has received grants from AstraZeneca during the conduct of the study and grants and personal fees from Bayer, Boehringer Ingelheim and Merck Sharp & Dohme Corp, a subsidiary of Merck & Co, Inc; personal fees from Novartis, Amgen, and Servier; and financial support from Elcelyx, GlaxoSmithKline, Janssen, and Takeda outside the submitted work. Dr Peterson: has received grants from Janssen, Merck, Sanofi, AstraZeneca, Genentech, and Amgen, and has consulting associations with Janssen, Bayer, Merck, and Sanofi. |
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| Funding: The TECOS trial was funded by Merck Sharp & Dohme Corp, a subsidiary of Merck & Co, Inc, Kenilworth, NJ, USA. |
Vol 218
P. 92-99 - décembre 2019 Retour au numéro
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