Risk of Cardiovascular Events in Patients With Diabetes Mellitus on β-Blockers

Tetsuro Tsujimoto, Takehiro Sugiyama, Martin F Shapiro, Mitsuhiko Noda, Hiroshi Kajio, Tetsuro Tsujimoto, Takehiro Sugiyama, Martin F Shapiro, Mitsuhiko Noda, Hiroshi Kajio

Abstract

Although the use of β-blockers may help in achieving maximum effects of intensive glycemic control because of a decrease in the adverse effects after severe hypoglycemia, they pose a potential risk for the occurrence of severe hypoglycemia. This study aimed to evaluate whether the use of β-blockers is effective in patients with diabetes mellitus and whether its use is associated with the occurrence of severe hypoglycemia. Using the ACCORD trial (Action to Control Cardiovascular Risk in Diabetes) data, we performed Cox proportional hazards analyses with a propensity score adjustment. The primary outcome was the first occurrence of a cardiovascular event during the study period, which included nonfatal myocardial infarction, unstable angina, nonfatal stroke, and cardiovascular death. The mean follow-up periods (±SD) were 4.6±1.6 years in patients on β-blockers (n=2527) and 4.7±1.6 years in those not on β-blockers (n=2527). The cardiovascular event rate was significantly higher in patients on β-blockers than in those not on β-blockers (hazard ratio, 1.46; 95% confidence interval, 1.24-1.72; P<0.001). In patients with coronary heart disease or heart failure, the cumulative event rate for cardiovascular events was also significantly higher in those on β-blockers than in those not on β-blockers (hazard ratio, 1.27; 95% confidence interval, 1.02-1.60; P=0.03). The incidence of severe hypoglycemia was significantly higher in patients on β-blockers than in those not on β-blockers (hazard ratio, 1.30; 95% confidence interval, 1.03-1.64; P=0.02). In conclusion, the use of β-blockers in patients with diabetes mellitus was associated with an increased risk for cardiovascular events.

Keywords: ACCORD trial; cardiovascular disease; coronary heart disease; diabetes mellitus; severe hypoglycemia; β-blocker.

© 2017 The Authors.

Figures

Figure 1.
Figure 1.
Kaplan–Meier survival curves for cardiovascular events and all-cause and cardiovascular deaths in patients on and not on β-blockers. Rates of freedom from cardiovascular events (A and B), all-cause death (C and D), and cardiovascular death (E and F). β indicates β-blockers; Intensive, intensive therapy; and Standard, standard therapy.
Figure 2.
Figure 2.
Kaplan–Meier survival curves for cardiovascular events and all-cause and cardiovascular deaths in patients on and not on β-blockers who had history of coronary heart disease or heart failure. Rates of freedom from cardiovascular events (A), all-cause death (B), and cardiovascular death (C). β indicates β-blockers.
Figure 3.
Figure 3.
Kaplan–Meier survival curves for severe hypoglycemia in patients on and not on β-blockers. β indicates β-blockers; Intensive, intensive therapy; and Standard, standard therapy.

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Source: PubMed

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