CLINICAL STUDIES
Beta-adrenergic blocking agent use and mortality in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a post hoc analysis of the studies of left ventricular dysfunction
Derek V. Exner, MD1,*,
Daniel L. Dries, MD, MPH*,
Myron A. Waclawiw, PhD ,
Brent Shelton, PhD and
Michael J. Domanski, MD, FACC*
* Clinical Trials Scientific Research Group, National Heart, Lung and Blood Institute, Bethesda, Maryland, USA
Office of Biostatistics Research, National Heart, Lung and Blood Institute, Bethesda, Maryland, USA
Section on Biostatistics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
Manuscript received August 7, 1998;
revised manuscript received October 23, 1998,
accepted December 15, 1998.
Reprint requests and correspondence: Dr. Derek V. Exner, National Heart, Lung and Blood Institute, II, 6701 Rockledge Drive; Room 8146, Bethesda, Maryland 20892
ExnerD{at}gwgate.nhlbi.nih.gov
OBJECTIVES
This analysis was performed to assess whether beta-adrenergic blocking agent use is associated with reduced mortality in the Studies of Left Ventricular Dysfunction (SOLVD) and to determine if this relationship is altered by angiotensin-converting enzyme (ACE) inhibitor use.
BACKGROUND
The ability of beta-blockers to alter mortality in patients with asymptomatic left ventricular dysfunction is not well defined. Furthermore, the effect of beta-blocker use, in addition to an ACE inhibitor, on these patients has not been fully addressed.
METHODS
This retrospective analysis evaluated the association of baseline beta-blocker use with mortality in 4,223 mostly asymptomatic Prevention trial patients, and 2,567 symptomatic Treatment trial patients.
RESULTS
The 1,015 (24%) Prevention trial patients and 197 (8%) Treatment trial patients receiving beta-blockers had fewer symptoms, higher ejection fractions and different use of medications than patients not receiving beta-blockers. On univariate analysis, beta-blocker use was associated with significantly lower mortality than nonuse in both trials. Moreover, a synergistic reduction in mortality with use of both a beta-blocker and enalapril was suggested in the Prevention trial. After adjusting for important prognostic variables with Cox multivariate analysis, the association of beta-adrenergic blocking agent use with reduced mortality remained significant for Prevention trial patients receiving enalapril. Lower rates of arrhythmic and pump failure death and risk of death or hospitalization for heart failure were observed.
CONCLUSIONS
The combination of a beta-blocker and enalapril was associated with a synergistic reduction in the risk of death in the SOLVD Prevention trial.
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Abbreviations and Acronyms
| | ACE | = angiotensin-converting enzyme | | CI | = confidence interval | | LV | = left ventricular | | NYHA | = New York Heart Association | | RR | = relative risk | | SAVE | = Survival and Ventricular Enlargement | | SOLVD | = Studies of Left Ventricular Dysfunction |
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