Metoprolol plus statin therapy reduces atherosclerosis risk

NEW YORK (Reuters Health) – Metoprolol treatment has anti-atherosclerotic benefits beyond those achieved with statin treatment alone, according to a report in the February issue of Stroke: Journal of the American Heart Association.

Previous animal and clinical studies suggest that beta-blockade might prevent atherosclerosis by protecting the endothelium from psychosocial stress-mediated injury, as well as by reducing lipoprotein deposition, the authors explain, but these are "the first clinical data to show an anti-atherosclerotic effect of beta-blockade as additional therapy to statins."

Dr. Johannes Hulthe, from Sahlgrenska University/Sahlgrenska in Gothenburg, Sweden, and colleagues studied the effects of treatment with controlled release/extended release metoprolol on the progression of atherosclerosis, as measured by carotid intima-media thickness (IMT). Ninety-two hypercholesterolemic patients, who were already receiving and continued on statin therapy, were randomized to metoprolol or placebo.

Though metoprolol treatment resulted in lower heart rates, the findings indicate, systolic and diastolic blood pressures did not differ between the metoprolol-treated group and control group.

LDL cholesterol levels were reduced to a comparable extent in both groups, the researchers note, and HDL cholesterol and triglyceride levels did not differ between the two groups.

In contrast, IMT in the carotid bulb and in the composite carotid bulb IMT plus common carotid IMT decreased significantly after 1 year of metoprolol treatment, the authors note, an effect not seen in the statins-only group.

At 3-year follow-up, 79 patients were available for evaluation. In these subjects, the composite IMT measurement still differed significantly, with slower progression in the metoprolol-treated patients.

Mean values for lumen diameter did not differ significantly between the two groups, the report indicates.

"Our results suggest a beneficial effect of beta-blockade on atherosclerosis development in patients with hypercholesterolemia, beyond that provided by lipid-lowering treatment with statins," the authors conclude.

"Patients with hypercholesterolemia have a 10-fold increase for CHD, and beta-blockers seem to be important for prevention of MI, sudden death, stroke, and other cardiovascular events in these patients," Dr. Hulthe told Reuters Health.

"Statins have been shown to provide a pronounced risk reduction in patients with hypercholesterolemia and obviously work very nicely in combination treatment with a beta-blocker," Dr. Hulthe added.

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