Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Drugs & Aging
Published in: Drugs & Aging 1/2003

01-01-2003 | Leading Article

β-Blockers after Acute Myocardial Infarction in Elderly Patients with Diabetes Mellitus

Time to Reassess

Authors: Dr Mauro Di Bari, Niccolò Marchionni, Marco Pahor

Published in: Drugs & Aging | Issue 1/2003

Login to get access

Abstract

β-Blockers effectively reduce mortality and recurrent cardiovascular events in patients surviving myocardial infarction. However, these agents are underused in clinical practice, especially in older patients with diabetes mellitus. The current literature shows that β-blockers are at least as effective in older diabetic patients as in other patients, without major safety concerns for their possible adverse effects. The use of these agents in clinical practice should therefore be encouraged, in order to reduce the burden of cardiovascular mortality and morbidity in older diabetic patients post-infarction.
Literature
1.
Berger AK, Breall JA, Gersh BJ, et al. Effect of diabetes mellitus and insulin use on survival after acute myocardial infarction in the elderly (the Cooperative Cardiovascular Project). Am J Cardiol 2001; 87(3): 272–7PubMedCrossRef
2.
Abrahamsson P, Dellborg M, Rosengren A, et al. Improved long-term prognosis after myocardial infarction 1984–1991. Eur Heart J 1998; 19(10): 1512–7PubMedCrossRef
3.
Ryan TJ, Antman EM, Brooks NH, et al. 1999 update: ACC/AHA Guidelines for the management of patients with acute myocardial infarction: executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). Circulation 1999; 100(9): 1016–30PubMedCrossRef
4.
Aronow WS. Postinfarction use of beta-blockers in elderly patients. Drugs Aging 1997; 11(6): 424–32PubMedCrossRef
5.
Yusuf S, Wittes J, Friedman L. Overview of results of randomized clinical trials in heart disease. I. Treatments following myocardial infarction. JAMA 1988; 260(14): 2088–93PubMedCrossRef
6.
Yusuf S, Peto R, Lewis J, et al. Beta blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis 1985; 27(5): 335–71PubMedCrossRef
7.
Krumholz HM, Radford MJ, Wang Y, et al. National use and effectiveness of beta-blockers for the treatment of elderly patients after acute myocardial infarction: National Cooperative Cardiovascular Project. JAMA 1998; 280(7): 623–9PubMedCrossRef
8.
Beck CA, Lauzon C, Eisenberg MJ, et al. Discharge prescriptions following admission for acute myocardial infarction at tertiary care and community hospitals in Quebec. Can J Cardiol 2001; 17(1): 33–40PubMed
9.
Younis N, Burnham P, Patwala A, et al. Beta blocker prescribing differences in patients with and without diabetes following a first myocardial infarction. Diabet Med 2001; 18(2): 159–61PubMedCrossRef
10.
Nicholls SJ, McElduff P, Dobson AJ, et al. Underuse of beta-blockers following myocardial infarction: a tale of two cities. Intern Med J 2001; 31(7): 391–6PubMedCrossRef
11.
Soumerai SB, McLaughlin TJ, Spiegelman D, et al. Adverse outcomes of underuse of beta-blockers in elderly survivors of acute myocardial infarction. JAMA 1997; 277(2): 115–21PubMedCrossRef
12.
Gottlieb SS, McCarter RJ, Vogel RA. Effect of beta-blockade on mortality among high-risk and low-risk patients after myocardial infarction. N Engl J Med 1998; 339(8): 489–97PubMedCrossRef
13.
Barakat K, Wilkinson P, Deaner A, et al. How should age affect management of acute myocardial infarction? A prospective cohort study. Lancet 1999; 353(9157): 955–9PubMedCrossRef
14.
Malmberg K, Herlitz J, Hjalmarson A, et al. Effects of metoprolol on mortality and late infarction in diabetics with suspected acute myocardial infarction. Retrospective data from two large studies. Eur Heart J 1989; 10(5): 423–8PubMed
15.
Randomised trial of intravenous atenolol among 16 027 cases of suspected acute myocardial infarction: ISIS-1. First International Study of Infarct Survival Collaborative Group. Lancet 1986; 2(8498): 57–66
16.
Gundersen T, Kjekshus J. Timolol treatment after myocardial infarction in diabetic patients. Diabetes Care 1983; 6(3): 285–90PubMedCrossRef
17.
A randomized trial of propranolol in patients with acute myocardial infarction. I. Mortality results. JAMA 1982; 247(12): 1707–14
18.
The effect of pindolol on the two years mortality after complicated myocardial infarction. Eur Heart J 1983; 4(6): 367–75
19.
Kjekshus J, Gilpin E, Cali G, et al. Diabetic patients and beta-blockers after acute myocardial infarction. Eur Heart J 1990; 11(1): 43–50PubMed
20.
MacDonald TM, Butler R, Newton RW, et al. Which drugs benefit diabetic patients for secondary prevention of myocardial infarction? DARTS/MEMO Collaboration. Diabet Med 1998; 15(4): 282–9PubMedCrossRef
21.
Kendall MJ, Lynch KP, Hjalmarson A, et al. Beta-blockers and sudden cardiac death. Ann Intern Med 1995; 123(5): 358–67PubMed
22.
Jonas M, Reicher-Reiss H, Boyko V, et al. Usefulness of beta-blocker therapy in patients with non-insulin-dependent diabetes mellitus and coronary artery disease. Bezafibrate Infarction Prevention (BIP) Study Group. Am J Cardiol 1996; 77(15): 1273–7PubMedCrossRef
23.
Chen J, Marciniak TA, Radford MJ, et al. Beta-blocker therapy for secondary prevention of myocardial infarction in elderly diabetic patients. Results from the National Cooperative Cardiovascular Project. J Am Coll Cardiol 1999; 34(5): 1388–94PubMedCrossRef
24.
Löwel H, Koenig W, Engel S, et al. The impact of diabetes mellitus on survival after myocardial infarction: can it be modified by drug treatment?. Results of a population-based myocardial infarction register follow-up study. Diabetologia 2000; 43(2): 218–26PubMedCrossRef
25.
Aronow WS, Ahn C. Effect of beta blockers on incidence of new coronary events in older persons with prior myocardial infarction and diabetes mellitus. Am J Cardiol 2001; 87(6): 780–1, A8PubMedCrossRef
26.
Fihn SD, Williams SV, Daley J, et al. Guidelines for the management of patients with chronic stable angina: treatment. Ann Intern Med 2001; 135 (8 Pt 1): 616–32PubMed
27.
The Sixth Report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med 1997; 157(21): 2413–46
28.
Medical Research Council Working Party. MRC trial of treatment of mild hypertension: principal results. BMJ 1985; 291(6488): 97–104CrossRef
29.
SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991; 265(24): 3255–64CrossRef
30.
Dahlof B, Lindholm LH, Hansson L, et al. Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension). Lancet 1991; 338(8778): 1281–5PubMedCrossRef
31.
Maki M, Nuutila P, Laine H, et al. Myocardial glucose uptake in patients with NIDDM and stable coronary artery disease. Diabetes 1997; 46(9): 1491–6PubMedCrossRef
32.
Nuutila P, Knuuti J, Ruotsalainen U, et al. Insulin resistance is localized to skeletal but not heart muscle in type 1 diabetes. Am J Physiol 1993; 264 (5 Pt 1): E756–62PubMed
33.
Opie LH, Thomas M. Propranolol and experimental myocardial infarction: substrate effects. Postgrad Med J 1976; 52Suppl. 4: 124–32PubMed
34.
Wallhaus TR, Taylor M, DeGrado TR, et al. Myocardial free fatty acid and glucose use after carvedilol treatment in patients with congestive heart failure. Circulation 2001; 103(20): 2441–6PubMedCrossRef
35.
Opie LH. Metabolism of free fatty acids, glucose and catecholamines in acute myocardial infarction: relation to myocardial ischemia and infarct size. Am J Cardiol 1975; 36(7): 938–53PubMedCrossRef
36.
Ewing DJ. Diabetic autonomic neuropathy and the heart. Diabetes Res Clin Pract 1996; 30Suppl. 31 (6): 31–6PubMedCrossRef
37.
Bigger Jr JT, Fleiss JL, Rolnitzky LM, et al. Frequency domain measures of heart period variability to assess risk late after myocardial infarction. J Am Coll Cardiol 1993; 21(3): 729–36PubMedCrossRef
38.
Herlitz J, Hartford M, Pennert K, et al. Goteborg Metoprolol Trial: clinical observations. Am J Cardiol 1984; 53(13): 37D–45DPubMed
39.
Olsson G, Wikstrand J, Warnold I, et al. Metoprolol-induced reduction in postinfarction mortality: pooled results from five double-blind randomized trials. Eur Heart J 1992; 13(1): 28–32PubMed
40.
Hjalmarson A. Cardioprotection with beta-adrenoceptor blockers: does lipophilicity matter? Basic Res Cardiol 2000; 95Suppl. 1: I41–5PubMedCrossRef
41.
Hilleman DE, Bauman AL. Role of antiarrhythmic therapy in patients at risk for sudden cardiac death: an evidence-based review. Pharmacotherapy 2001; 21(5): 556–75PubMedCrossRef
42.
Andreka P, Aiyar N, Olson LC, et al. Bucindolol displays intrinsic sympathomimetic activity in human myocardium. Circulation 2002; 105(20): 2429–34PubMedCrossRef
43.
Goldstein S. Benefits of beta-blocker therapy for heart failure: weighing the evidence. Arch Intern Med 2002; 162(6): 641–8PubMedCrossRef
44.
A trial of the beta-blocker bucindolol in patients with advanced chronic heart failure. N Engl J Med 2001; 344(22): 1659–67
45.
The Xamoterol in Severe Heart Failure Study Group. Xamoterol in severe heart failure. Lancet 1990; 336(8706): 1–6CrossRef
46.
Mills GA, Horn JR. Beta-blockers and glucose control. Drug Intell Clin Pharm 1985; 19(4): 246–51PubMed
47.
Houston MC. Adverse effects of antihypertensive drug therapy on glucose intolerance. Cardiol Clin 1986; 4(1): 117–35PubMed
48.
Deacon SP, Karunanayake A, Barnett D. Acebutolol, atenolol, and propranolol and metabolic responses to acute hypoglycaemia in diabetics. BMJ 1977; 2(6097): 1255–7PubMedCrossRef
49.
Shorr RI, Ray WA, Daugherty JR, et al. Incidence and risk factors for serious hypoglycemia in older persons using insulin or sulfonylureas. Arch Intern Med 1997; 157(15): 1681–6PubMedCrossRef
50.
Greene DA. Acute and chronic complications of diabetes mellitus in older patients. Am J Med 1986; 80(5A): 39–53PubMedCrossRef
51.
Cahill Jr GF. Hyperglycemic hyperosmolar coma: a syndrome almost unique to the elderly. J Am Geriatr Soc 1983; 31(2): 103–5PubMed
52.
Herlitz J, Hjalmarson A, Holmberg S, et al. Development of congestive heart failure after treatment with metoprolol in acute myocardial infarction. Br Heart J 1984; 51(5): 539–44PubMedCrossRef
53.
Hansteen V, Moinichen E, Lorentsen E, et al. One year’s treatment with propranolol after myocardial infarction: preliminary report of Norwegian multicentre trial. BMJ 1982; 284(310): 155–60PubMedCrossRef
54.
Hunt SA, Baker DW, Chin MH, et al. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee to revise the 1995 guidelines for the evaluation and management of heart failure). J Am Coll Cardiol 2001; 38(7): 2101–13PubMedCrossRef
55.
Rochon PA, Tu JV, Anderson GM, et al. Rate of heart failure and 1-year survival for older people receiving low-dose beta-blocker therapy after myocardial infarction. Lancet 2000; 356(9230): 639–44PubMedCrossRef
56.
Dargie HJ. Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial. Lancet 2001; 357(9266): 1385–90PubMedCrossRef
57.
Baldasseroni S, Opasich C, Gorini M, et al. Left bundle-branch block is associated with increased one-year mortality in congestive heart failure: a report from the Italian Network on Congestive Heart Failure (IN-CHF database). Am Heart J 2002; 143(3): 398–405PubMedCrossRef
58.
Lager I, Blohme G, Smith U. Effect of cardioselective and non-selective beta-blockade on the hypoglycaemic response in insulin-dependent diabetics. Lancet 1979; 1(8114): 458–62PubMedCrossRef
59.
Shorr RI, Ray WA, Daugherty JR, et al. Antihypertensives and the risk of serious hypoglycemia in older persons using insulin or sulfonylureas. JAMA 1997; 278(1): 40–3PubMedCrossRef
60.
Jacob S, Rett K, Henriksen EJ. Antihypertensive therapy and insulin sensitivity: do we have to redefine the role of beta-blocking agents? Am J Hypertens 1998; 11(10): 1258–65PubMedCrossRef
61.
Giugliano D, Acampora R, Marfella R, et al. Metabolic and cardiovascular effects of carvedilol and atenolol in non-insulin-dependent diabetes mellitus and hypertension. A randomized, controlled trial. Ann Intern Med 1997; 126(12): 955–9PubMed
62.
UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. BMJ 1998; 317(7160): 713–20CrossRef
63.
Gress TW, Nieto FJ, Shahar E, et al. Hypertension and antihypertensive therapy as risk factors for type 2 diabetes mellitus. Atherosclerosis Risk in Communities Study. N Engl J Med 2000; 342(13): 905–12PubMedCrossRef
64.
Niskanen L, Hedner T, Hansson L, et al. Reduced cardiovascular morbidity and mortality in hypertensive diabetic patients on first-line therapy With an ACE inhibitor compared with a diuretic/beta-blocker-based treatment regimen: a subanalysis of the Captopril Prevention Project. Diabetes Care 2001; 24(12): 2091–6PubMedCrossRef
65.
Prichard BN, Graham BR, Cruickshank JM. New approaches to the uses of beta blocking drugs in hypertension. J Hum Hypertens 2000; 14Suppl 1: S63–8: S63-8PubMedCrossRef
66.
Hollenberg NK, Williams GH, Anderson R. Medical therapy, symptoms, and the distress the cause: relation to quality of life in patients with angina pectoris and/or hypertension. Arch Intern Med 2000; 160(10): 1477–83PubMedCrossRef
67.
Perez-Stable EJ, Halliday R, Gardiner PS, et al. The effects of propranolol on cognitive function and quality of life: a randomized trial among patients with diastolic hypertension. Am J Med 2000; 108(5): 359–65PubMedCrossRef
68.
Paran E, Anson O, Neumann L. The effects of replacing beta-blockers with an angiotensin converting enzyme inhibitor on the quality of life of hypertensive patients. Am J Hypertens 1996; 9 (12 Pt 1): 1206–13PubMedCrossRef
69.
Lewis CE, Grandits A, Flack J, et al. Efficacy and tolerance of antihypertensive treatment in men and women with stage 1 diastolic hypertension: results of the Treatment of Mild Hypertension Study. Arch Intern Med 1996; 156(4): 377–85PubMedCrossRef
70.
Applegate WB, Pressel S, Wittes J, et al. Impact of the treatment of isolated systolic hypertension on behavioral variables: results from the systolic hypertension in the elderly program. Arch Intern Med 1994; 154(19): 2154–60PubMedCrossRef
71.
Ekman M, Zethraeus N, Jonsson B. Cost effectiveness of bisoprolol in the treatment of chronic congestive heart failure in Sweden: analysis using data from the Cardiac Insufficiency Bisoprolol Study II trial. Pharmacoeconomics 2001; 19(9): 901–16PubMedCrossRef
72.
Dahlof C, Dimenas E, Kendall M, et al. Quality of life in cardiovascular diseases. Emphasis on beta-blocker treatment. Circulation 1991; 84 (6 Suppl.): VI108–18PubMed
Metadata
Title
β-Blockers after Acute Myocardial Infarction in Elderly Patients with Diabetes Mellitus
Time to Reassess
Authors
Dr Mauro Di Bari
Niccolò Marchionni
Marco Pahor
Publication date
01-01-2003
Publisher
Springer International Publishing
Published in
Drugs & Aging / Issue 1/2003
Print ISSN: 1170-229X
Electronic ISSN: 1179-1969
DOI
https://doi.org/10.2165/00002512-200320010-00002

Other articles of this Issue 1/2003

Drugs & Aging 1/2003 Go to the issue

Current Opinion

Colorectal Cancer in the Elderly

Therapy in Practice

Demographics, Assessment and Management of Pain in the Elderly

Review Article

Differential Pharmacokinetics of Theophylline in Elderly Patients

Therapy in Practice

Inflammatory Pancreatic Diseases in Older Patients
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits