CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 1, January – April 2024 AFRICA 39 ischemia–reperfusion injury. Basic Res Cardiol 2007; 102: 518–528. 27. Nazari A, Chehelcheraghi F. Using Apelin and exercise to protect the cardiac cells: synergic effect in ischemia reperfusion injuries treatment in rats. Bratisl Lek Listy 2020; 121(1): 14–21. 28. Smith CC, Mocanu MM, Bowen J, Wynne AM, Simpkin JC, Dixon RA, et al. Temporal changes in myocardial salvage kinases during reperfusion following ischemia: studies involving the cardioprotective adipocytokine apelin. Cardiovasc Drugs Ther 2007; 21: 409–414. 29. Saks VA, Kaambre T, Sikk P, Eimre M, Orlova E, Paju K, et al. Intracellular energetic units in red muscle cells. Biochem J 2001; 356: 643–657. 30. Kaasik A, Veksler V, Boehm E, Novotova M, Minajeva A, VenturaClapier R. Energetic crosstalk between organelles: architectural integration of energy production and utilization. Circ Res 2001; 89: 153–159. 31. Ke Q, Costa M. Hypoxia-inducible factor-1 (HIF-1). Mol Pharmacol 2006; 70: 1469–1480. 32. Tekin D, Dursun AD, Xi L. Hypoxia inducible factor 1 (HIF-1) and cardioprotection. Acta Pharmacol Sin 2010; 31: 1085–1094. Two studies find beta-blockers not always ideal for heart patients Beta-blockers have long been widely prescribed for patients with heart issues, but two recent studies question the benefit of the therapies in certain patients with strong heart function, one finding that long-term use of the drug did not lead to improved cardiovascular outcomes, the second one linking beta-blockers to more risk of hospitalisation. STAT reports that the first one, published in the journal Heart, looked at people who’d had a heart attack but didn’t develop heart failure or dysfunction in their heart’s pumping. Researchers found that long-term beta-blocker use wasn’t associated with improved cardiovascular outcomes in this group. The other study, published in J Am Coll Cardiol: Heart Failure, focused on people with heart failure who had mildly reduced and normal ejection fraction, a measure of a heart’s squeezing function. The authors found that beta-blockers were linked to a greater risk of hospital admission in patients with higher squeezing power. Beta-blockers lead the heart to beat more slowly and are meant to lower stress on the heart. Doctors have been prescribing the medications based on data from decades ago, before recent advancements in cardiovascular care, and patients also often have co-morbidities that lead doctors to prescribe beta-blockers. While the two studies are both observational, and the authors stressed the need formore research that follows patients over time, the findings still suggest that the longstanding practice of prescribing beta-blockers merits reassessment. Lakshmi Sridharan, anadvancedheart failure and transplant cardiologist at Emory University who wasn’t involved in the studies, said the data are ‘all pointing to a similar direction that not all patients whom we used to historically, reflexively put on beta-blockers, benefit from them’. The study in Heart analysed health records from more than 43 000 adults in Sweden who experienced a heart attack but didn’t have heart failure or pumping dysfunction. While there’s research supporting the use of beta-blockers shortly after a heart attack in these types of patients, there’s little data looking at longer-term use, so the researchers focused on beta-blocker usage one year after a heart attack. Of the patients studied, most of them (79%) were on beta-blockers a year after a heart attack. After adjusting and weighting for factors such as demographics and co-morbidities, the researchers found no difference in the risk of death and cardiovascular incidents between people who were and weren’t on beta-blockers during a median follow up of 4.5 years. Gorav Batra, the senior author and consultant cardiologist at Uppsala University in Sweden, said the care and treatment of patients with heart attacks has vastly improved over the past three decades. That means patients experience less injury to their heart muscle from heart attacks, and so they may not need beta-blockers long term to help them. Sridharan noted that since the study was conducted in Sweden, its findings may not be generalisable to the US population. Still, she said, it’s important to examine the use of beta-blockers since heart attack care has advanced and since the drugs can come with side effects that affect patients’ quality of life, such as fatigue and depression. ‘That’s when the question of the risk–benefit ratio really comes into play for these patients,’ she said. The other study in J Am Coll Cardiol: Heart Failure looked at more than 400 000 people in the USA over 65 years who had heart failure with mildly reduced or normal squeezing function, described as an ejection fraction greater than 40%. While studies have consistently shown the benefit of betablockers in heart failure patients with significantly reduced squeezing power, measured as an ejection fraction less than 40%, there’s limited data on use of the drugs in people with stronger squeezing function. Yet again here, most patients studied (66%) were on betablockers. After adjusting for factors such as co-morbidities and health history, and in a median follow up of 38 months, the researchers found that as the ejection fraction number increased, the risk of hospitalisation for heart failure linked to beta-blocker use also increased. Among patients with a mildly reduced ejection fraction, beta-blockers were associated with a lower risk of hospitalisation and death. But among patients with greater squeezing function, particularly those with an ejection fraction over 60%, beta-blockers were linked to higher hospitalisation rates. The researchers also found that this trend held whether or not patients had hypertension, an irregular heartbeat, or coronary artery disease, which are three co-morbidities that currently lead doctors to prescribe beta-blockers. The study suggests ‘you really have to pay attention to what the ejection fraction is’ when treating heart failure patients, said Suzanne Arnold, the lead author and a professor of medicine at the University of Missouri-Kansas City. Source: MedicalBrief 2023
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