Type of β-blocker use among patients with versus without diabetes after myocardial infarction

Am Heart J. 2014 Sep;168(3):273-279.e1. doi: 10.1016/j.ahj.2014.04.018. Epub 2014 Jun 9.

Abstract

Background: Discharge β-blocker prescription after myocardial infarction (MI) is recommended for all eligible patients. Numerous β-blocker choices are presently available with variable glycometabolic effects, which could be an important consideration in patients with diabetes mellitus (DM). Whether patients with DM preferentially receive β-blockers with favorable metabolic effects after MI and if this choice is associated with better glycemic control postdischarge is unknown.

Methods: Among patients from 24 US hospitals enrolled in an MI registry (2005-2008), we investigated the frequency of "DM-friendly" β-blocker prescription at discharge by DM status. β-Blockers were classified as DM-friendly (eg, carvedilol and labetalol) or non-DM-friendly (eg, metoprolol and atenolol), based on their effects on glycemic control. Hierarchical, multivariable logistic regression examined the association of DM with DM-friendly β-blocker use. Among DM patients, we examined the association of DM-friendly β-blockers with worsened glycemic control at 6 months after MI.

Results: Of 4,031 MI patients, 1,382 (34%) had DM. β-Blockers were prescribed at discharge in 93% of patients. Diabetes mellitus-friendly β-blocker use was low regardless of DM status, although patients with DM were more likely to be discharged on a DM-friendly β-blocker compared with patients without DM (13.5% vs 10.3%, P = .003), an association that remained after multivariable adjustment (odds ratio 1.41, 95% CI 1.13-1.77). There was a trend toward a lower risk of worsened glucose control at 6 months in DM patients prescribed DM-friendly versus non-DM-friendly β-blockers (Relative Risk 0.80, 95% CI 0.60-1.08).

Conclusion: Most DM patients were prescribed non-DM-friendly β-blockers-a practice that was associated with a trend toward worse glycemic control postdischarge. Although in need of further confirmation in larger studies, our findings highlight an opportunity to improve current practices of β-blockers use in patients with DM.

Publication types

  • Comparative Study

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use*
  • Aged
  • Carbazoles / therapeutic use
  • Carvedilol
  • Contraindications
  • Diabetic Angiopathies / drug therapy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / drug therapy*
  • Practice Patterns, Physicians'*
  • Propanolamines / therapeutic use
  • Registries

Substances

  • Adrenergic beta-Antagonists
  • Carbazoles
  • Propanolamines
  • Carvedilol