Abstract 3726: Beta-Blockers and Progression of Coronary Atherosclerosis:A Meta-Analysis from Four Intravascular Ultrasound Trials
Background: It is not known whether beta-blockers have a direct anti-atherosclerotic action in the coronary arteries, which can be one of the mechanisms of their beneficial effects. Our objective was to evaluate this by using serial intravascular ultrasound (IVUS).
Methods: 1515 patients with coronary disease completing the REVERSAL, CAMELOT, ACTIVATE, and ASTEROID trials were included in a meta-analysis. The annualized change in atheroma volume as determined by IVUS was compared in patients with and without concomitant beta-blocker treatment, after adjusting for possible confounders.
Results: Patients on beta-blockers (n=1154) were more likely to have histories of myocardial infarction, angina and hypertension, as compared to those not having beta-blocker treatment (n=361). The progression rate was significantly less in patients on beta-blockers, both on univariable (−1.9±0.5 vs. 0.1±0.8 mm3/year, p=0.02) and multivariable analysis controlling for histories of myocardial infarction, angina and hypertension (−2.0±0.5 vs. 0.3±0.9 mm3/year, p=0.01). Additional adjustments for blood pressure, concomitant medications and propensity scoring did not change the results. The anti-atherosclerotic action of beta-blockers was evident in patients with both higher and lower on study low-density lipoprotein levels (Figure⇓).
Conclusion: This meta-analysis demonstrates that beta-blockers slow progression of coronary atherosclerosis. Our findings provide additional support for the current clinical guidelines advocating long-term use of beta-blockers in most forms of coronary artery disease.