Usefulness of beta-blocker therapy in patients with non-insulin-dependent diabetes mellitus and coronary artery disease

• Published in: The American journal of cardiology 1996-06, Vol.77 (15), p.1273-1277
• Main Authors: Jonas, Michael, Reicher-Reiss, Henrietta, Boyko, Valentina, Shotan, Avraham, Mandelzweig, Lori, Goldbourt, Uri, Behar, Solomon
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Cardiovascular disease; Cardiovascular system; Diabetes; Drug therapy; Medical research; Medical sciences; Miscellaneous; Pharmacology. Drug treatments
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(96)00191-9

The benefit of β-blocker therapy in patients after myocardial infarction is well established. The use of β blockers in the high-risk subgroup of patients with combined diabetes mellitus (DM) and coronary artery disease (CAD) remains controversial. From a database of 14,417 patients with chronic CAD who had been screened for participation in the Bezafibrate Infarction Prevention (BIP) study, 2,723 (19%) had non-insulin-dependent DM. Baseline characteristics and 3-year mortality were analyzed in patients with DM receiving (n = 911; 33%) and not receiving (n = 1,812; 67%) β blockers. Total mortality during a 3-year follow-up was 7.8% in those receiving β blockers compared with 14.0% in those who were not (a 44% reduction). A reduction in cardiac mortality of 42% between the 2 groups was also noted. Three-year survival curves showed significant differences in mortality with increasing divergence (p = 0.0001). After multiple adjustment, multivariate analysis identified β-blocker therapy as a significant independent contributor to improved survival (relative risk = 0.58; 90% confidence interval 0.46 to 0.74). Within the diabetic population, the main benefit associated with β-blocker therapy was observed in older patients, in those with a history of myocardial infarction, those with limited functional capacity, and those at lower risk. Thus, therapy with β blockers appears to be associated with improved long-term survival in the high-risk subpopulation of patients with DM and CAD.