B-blockers, calcium antagonists, and mortality in stable coronary artery disease: An international cohort study
Aims: The effect of first-line antianginal agents, β-blockers, and calcium antagonists on clinical outcomes in stable coronary artery disease (CAD) remains uncertain. Methods and results We analysed the use of β-blockers or calcium antagonists (baseline and annually) and outcomes in 22 006 stab...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Journal Article |
| Language: | English |
| Published: |
2019
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| Subjects: | |
| Online Access: | http://hdl.handle.net/20.500.11937/80057 |
| _version_ | 1848764151348854784 |
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| author | Sorbets, E. Steg, P.G. Young, R. Danchin, N. Greenlaw, N. Ford, I. Tendera, M. Ferrari, R. Merkely, B. Parkhomenko, A. Reid, Christopher Tardif, J.C. Fox, K.M. |
| author_facet | Sorbets, E. Steg, P.G. Young, R. Danchin, N. Greenlaw, N. Ford, I. Tendera, M. Ferrari, R. Merkely, B. Parkhomenko, A. Reid, Christopher Tardif, J.C. Fox, K.M. |
| author_sort | Sorbets, E. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | Aims:
The effect of first-line antianginal agents, β-blockers, and calcium antagonists on clinical outcomes in stable coronary artery disease (CAD) remains uncertain.
Methods and results
We analysed the use of β-blockers or calcium antagonists (baseline and annually) and outcomes in 22 006 stable CAD patients (enrolled 2009–2010) followed annually to 5 years, in the CLARIFY registry (45 countries). Primary outcome was all-cause death. Secondary outcomes were cardiovascular death and the composite of cardiovascular death/non-fatal myocardial infarction (MI). After multivariable adjustment, baseline β-blocker use was not associated with lower all-cause death [1345 (7.8%) in users vs. 407 (8.4%) in non-users; hazard ratio (HR) 0.94, 95% confidence interval (CI) 0.84–1.06; P = 0.30]; cardiovascular death [861 (5.0%) vs. 262 (5.4%); HR 0.91, 95% CI 0.79–1.05; P = 0.20]; or cardiovascular death/non-fatal MI [1272 (7.4%) vs. 340 (7.0%); HR 1.03, 95% CI 0.91–1.16; P = 0.66]. Sensitivity analyses according to β-blocker use over time and to prescribed dose produced similar results. Among prior MI patients, for those enrolled in the year following MI, baseline β-blocker use was associated with lower all-cause death [205 (7.0%) vs. 59 (10.3%); HR 0.68, 95% CI 0.50–0.91; P = 0.01]; cardiovascular death [132 (4.5%) vs. 49 (8.5%); HR 0.52, 95% CI 0.37–0.73; P = 0.0001]; and cardiovascular death/non-fatal MI [212 (7.2%) vs. 59 (10.3%); HR 0.69, 95% CI 0.52–0.93; P = 0.01]. Calcium antagonists were not associated with any difference in mortality.
Conclusion
In this contemporary cohort of stable CAD, β-blocker use was associated with lower 5-year mortality only in patients enrolled in the year following MI. Use of calcium antagonists was not associated with superior mortality, regardless of history of MI. |
| first_indexed | 2025-11-14T11:14:48Z |
| format | Journal Article |
| id | curtin-20.500.11937-80057 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| language | eng |
| last_indexed | 2025-11-14T11:14:48Z |
| publishDate | 2019 |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-800572021-01-05T08:07:08Z B-blockers, calcium antagonists, and mortality in stable coronary artery disease: An international cohort study Sorbets, E. Steg, P.G. Young, R. Danchin, N. Greenlaw, N. Ford, I. Tendera, M. Ferrari, R. Merkely, B. Parkhomenko, A. Reid, Christopher Tardif, J.C. Fox, K.M. Beta-blockers Calcium antagonists Mortality Prognosis Stable coronary artery disease Aims: The effect of first-line antianginal agents, β-blockers, and calcium antagonists on clinical outcomes in stable coronary artery disease (CAD) remains uncertain. Methods and results We analysed the use of β-blockers or calcium antagonists (baseline and annually) and outcomes in 22 006 stable CAD patients (enrolled 2009–2010) followed annually to 5 years, in the CLARIFY registry (45 countries). Primary outcome was all-cause death. Secondary outcomes were cardiovascular death and the composite of cardiovascular death/non-fatal myocardial infarction (MI). After multivariable adjustment, baseline β-blocker use was not associated with lower all-cause death [1345 (7.8%) in users vs. 407 (8.4%) in non-users; hazard ratio (HR) 0.94, 95% confidence interval (CI) 0.84–1.06; P = 0.30]; cardiovascular death [861 (5.0%) vs. 262 (5.4%); HR 0.91, 95% CI 0.79–1.05; P = 0.20]; or cardiovascular death/non-fatal MI [1272 (7.4%) vs. 340 (7.0%); HR 1.03, 95% CI 0.91–1.16; P = 0.66]. Sensitivity analyses according to β-blocker use over time and to prescribed dose produced similar results. Among prior MI patients, for those enrolled in the year following MI, baseline β-blocker use was associated with lower all-cause death [205 (7.0%) vs. 59 (10.3%); HR 0.68, 95% CI 0.50–0.91; P = 0.01]; cardiovascular death [132 (4.5%) vs. 49 (8.5%); HR 0.52, 95% CI 0.37–0.73; P = 0.0001]; and cardiovascular death/non-fatal MI [212 (7.2%) vs. 59 (10.3%); HR 0.69, 95% CI 0.52–0.93; P = 0.01]. Calcium antagonists were not associated with any difference in mortality. Conclusion In this contemporary cohort of stable CAD, β-blocker use was associated with lower 5-year mortality only in patients enrolled in the year following MI. Use of calcium antagonists was not associated with superior mortality, regardless of history of MI. 2019 Journal Article http://hdl.handle.net/20.500.11937/80057 10.1093/eurheartj/ehy811 eng http://creativecommons.org/licenses/by/4.0/ fulltext |
| spellingShingle | Beta-blockers Calcium antagonists Mortality Prognosis Stable coronary artery disease Sorbets, E. Steg, P.G. Young, R. Danchin, N. Greenlaw, N. Ford, I. Tendera, M. Ferrari, R. Merkely, B. Parkhomenko, A. Reid, Christopher Tardif, J.C. Fox, K.M. B-blockers, calcium antagonists, and mortality in stable coronary artery disease: An international cohort study |
| title | B-blockers, calcium antagonists, and mortality in stable coronary artery disease: An international cohort study |
| title_full | B-blockers, calcium antagonists, and mortality in stable coronary artery disease: An international cohort study |
| title_fullStr | B-blockers, calcium antagonists, and mortality in stable coronary artery disease: An international cohort study |
| title_full_unstemmed | B-blockers, calcium antagonists, and mortality in stable coronary artery disease: An international cohort study |
| title_short | B-blockers, calcium antagonists, and mortality in stable coronary artery disease: An international cohort study |
| title_sort | b-blockers, calcium antagonists, and mortality in stable coronary artery disease: an international cohort study |
| topic | Beta-blockers Calcium antagonists Mortality Prognosis Stable coronary artery disease |
| url | http://hdl.handle.net/20.500.11937/80057 |