Association of Major Adverse Cardiac Events and Beta-Blockers in Patients with and without Atherosclerotic Cardiovascular Disease: Long-Term Follow-Up Results of the T-SPARCLE and T-PPARCLE Registry in Taiwan

• Published in: Journal of clinical medicine Vol. 12; no. 6; p. 2162
• Main Authors: Liu, Patrick Yan-Tyng, Lin, Fang-Ju, Yeh, Chih-Fan, Hsiao, Yu-Chung, Hsuan, Chin-Feng, Chang, Wei-Tien, Kao, Hsien-Li, Jeng, Jiann-Shing, Wu, Yen-Wen, Hsieh, I-Chang, Fang, Ching-Chang, Wang, Kuo-Yang, Chang, Kuan-Cheng, Lin, Tsung-Hsien, Sheu, Wayne Huey-Herng, Li, Yi-Heng, Yin, Wei-Hsian, Yeh, Hung-I, Chen, Jaw-Wen, Wu, Chau-Chung
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 10.03.2023; MDPI
• Subjects: Acute coronary syndromes; Adrenergic beta blockers; Atherosclerosis; Cardiovascular disease; Clinical medicine; Complications and side effects; Drug therapy; Heart diseases; Mortality; Patient outcomes; Prevention; Risk factors; Statins; Statistics; Stroke; Taiwan; major adverse cardiac events; beta-blocker; event-free survival; atherosclerotic cardiovascular disease; Taiwan cohort
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm12062162

Beta-blockers are widely used, but the benefit is now challenged in patients at risk of atherosclerotic cardiovascular disease (ASCVD) in the present coronary reperfusion era. We aimed to identify the risk factors of a major adverse cardiac event (MACE) and the long-term effect of beta-blockers in two large cohorts in Taiwan. Two prospective observational cohorts, including patients with known atherosclerosis cardiovascular disease (T-SPARCLE) and patients with at least one risk factor of ASCVD but without clinically evident ASCVD (T-PPARCLE), were conducted in Taiwan. The primary endpoint is the time of first occurrence of a MACE (cardiovascular death, nonfatal stroke, nonfatal myocardial infarction, and cardiac arrest with resuscitation). Between December 2009 and November 2014, with a median 2.4 years follow-up, 11,747 eligible patients (6921 and 4826 in T-SPARCLE and T-PPARCLE, respectively) were enrolled. Among them, 273 patients (2.3%) met the primary endpoint. With multivariate Cox PH model analysis, usage of beta-blocker was lower in patients with MACE (42.9% vs. 52.4%, < 0.01). In patients with ASCVD, beta-blocker usage was associated with lower MACEs (hazard ratio 0.72; < 0.001), but not in patients without ASCVD. The event-free survival of beta-blocker users remained higher during the follow-up period ( < 0.005) of ASCVD patients. In conclusion, in ASCVD patients, reduced MACE was associated with beta-blocker usage, and the effect was maintained during a six-year follow-up. Prescribing beta-blockers as secondary prevention is reasonable in the Taiwanese population.