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Effects of β‐blockers on all‐cause mortality in patients with type 2 diabetes and coronary heart disease
Author(s) -
Tsujimoto Tetsuro,
Sugiyama Takehiro,
Kajio Hiroshi
Publication year - 2017
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.12878
Subject(s) - medicine , hazard ratio , heart failure , cardiology , ejection fraction , myocardial infarction , diabetes mellitus , type 2 diabetes , proportional hazards model , confidence interval , incidence (geometry) , endocrinology , physics , optics
Aims To assess whether the use of beta‐blockers influences mortality and the incidence of major cardiovascular events in patients with diabetes and coronary heart disease (CHD). Materials and methods Using data from the B ypass A ngioplasty R evascularization I nvestigation 2 D iabetes trial, we performed C ox proportional hazards analysis to assess the effects of β‐blockers on all‐cause mortality in 2244 patients with type 2 diabetes who had stable CHD with and without a history of myocardial infarction ( MI )/heart failure with reduced left ventricular ejection fraction ( HFrEF ). Results All‐cause mortality in patients with MI / HFrEF was significantly lower in those receiving β‐blockers than in those not receiving β‐blockers (adjusted hazard ratio [ HR ] 0.60, 95% confidence interval [ CI ] 0.37‐0.98; P = .04), whereas that in patients without MI / HFrEF did not significantly differ (adjusted HR 0.91, 95% CI 0.76‐1.32; P = .64). Among patients with MI / HFrEF , all‐cause mortality in those who received intensive medical therapy alone for CHD was significantly lower in those on β‐blockers than in those not on β‐blockers (adjusted HR 0.45, 95% CI 0.23‐0.88; P = .02); however, mortality in patients who received early revascularization for CHD was not significantly lower in those on β‐blockers (adjusted HR 0.81, 95% CI 0.40‐1.65; P = .57). The risk of major cardiovascular events in patients without MI / HFrEF was not significantly different between those on and those not on β‐blocker treatment. Conclusions In patients with diabetes and CHD , the use of β‐blockers was effective in reducing all‐cause mortality in those with MI / HFrEF but not in those without MI / HFrEF .