A class of drugs called beta-blockers – used for decades as a first-line treatment after a heart attack – does not benefit the vast majority of patients and may contribute to a higher risk of hospitalization and death in some women, but not in men, according to groundbreaking new research.
"These findings will reshape all international clinical guidelines for the use of beta-blockers in men and women and should encourage a new, gender-based approach to the treatment of cardiovascular disease," said the study's lead author, Dr. Valentin Fuster, chairman of Mount Sinai Fuster Heart Hospital in New York and director general of the National Center for Cardiovascular Research in Madrid.
Women with mild heart damage after attacks who were treated with beta-blockers were significantly more likely to have another heart attack or be hospitalized for heart failure — and almost three times more likely to die — compared with women who did not take the drug, according to a study published in the Journal of the American Heart Association. European Heart Journal and which is also expected to be presented on Saturday at the European Society of Cardiology Congress in Madrid, writes CNN.
“This was especially true for women taking high doses of beta-blockers,” said the study’s lead author, Dr. Borja Ibáñez, scientific director of the National Center for Cardiovascular Research in Madrid.
"The total number of women in the clinical trial was the largest ever included in a study testing beta-blockers after myocardial infarction (heart attack), so this is an important finding," said Ibáñez, a cardiologist at the Jiménez Díaz Foundation University Hospital in Madrid.
However, the findings only applied to women with a left ventricular ejection fraction above 50%, which is considered normal function, the study said. Ejection fraction is a way to measure how well the left side of the heart pumps oxygenated blood around the body. For anyone with a score below 40% after a heart attack, beta-blockers remain the standard of care because of their ability to calm heart arrhythmias that can cause a second attack.
However, the drug can have unpleasant side effects, said Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver.
"The medications can lead to low blood pressure, low heart rate, erectile dysfunction, fatigue and mood swings," said Freeman, who was not involved in the research. "Whenever we use these medications, we always have to balance the risk against the benefit."
Why would women be more susceptible to harm from beta-blockers than men?
"This is actually not surprising," Freeman said. "Gender has a lot to do with how people respond to medications. In many cases, women have smaller hearts. They are more sensitive to blood pressure medications. Part of this may have to do with size, and part of this may have to do with other factors that we don't fully understand yet."
In fact, because early heart research focused on men, it took medical science years to discover that heart disease manifests differently in women. Men typically have plaque buildup in their major arteries and experience more traditional signs of a heart attack, such as chest pain. Women are more likely to have plaque in the smaller vessels of the heart and may have more unusual heart attack symptoms, such as back pain, indigestion, and shortness of breath.
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