Heart Health Beta-Blockers Reduced Cardiovascular Events: Research Trials

The Betami and Danblock trials investigated the effect of beta-blockers vs. no beta-blockers on the primary endpoint of all-cause mortality and major adverse cardiovascular events in patients after an MI with LVEF ≥40 %. A significant reduction in the primary endpoint was observed with beta-blockers compared with no beta-blockers. These results suggest that, despite advances in contemporary MI treatment, the beneficial effects of beta-blockers remain clinically relevant, even in patients with preserved or mildly reduced LVEF.

Madrid/Spain – Beta-blocker therapy significantly reduced a composite endpoint of all-cause mortality and major adverse cardiovascular events compared with no beta-blocker therapy in patients with myocardial infarction (MI) and preserved or mildly reduced left ventricular ejection fraction (LVEF), according to late-breaking research from the Betami and Danblock trials presented in a Hot Line session recently at the ESC Congress 2025 and simultaneously published in the New England Journal of Medicine.

“Evidence supporting beta-blocker therapy after MI was established before the introduction of modern coronary reperfusion therapy and secondary prevention strategies,” explained Principal Co-Investigator and presenter, Professor Dan Atar from Oslo University Hospital Ullevaal, Norway. “And while beta-blockers are strongly recommended for patients with MI and reduced LVEF, their role in MI patients with preserved or mildly reduced LVEF (≥40 %) without heart failure is less certain,” he noted. Two randomized trials with almost identical designs – the Norwegian Betami trial and the Danish Danblock trial – were combined to assess the effects of beta-blocker therapy on cardiovascular outcomes in patients after MI who had LVEF ≥40 % and no clinical heart failure.

In the two randomized open-label blinded-endpoint trials, eligible participants were enrolled within 7 days (Betami) or 14 days (Danblock) of an MI if they had LVEF ≥40 % and no clinical diagnosis of heart failure. Participants were randomized 1:1 to long-term beta-blocker or no beta-blocker therapy. The primary endpoint was a composite of all-cause mortality, new MI, unplanned coronary revascularisation, ischaemic stroke, heart failure or malignant ventricular arrhythmias.

Among 5,574 participants who underwent randomization, the median age was 63 years and 20.8 % were women. A total of 10.5 % had a history of coronary artery disease and 8.4 % were on beta-blocker treatment prior to enrolment.

After a median follow-up of 3.5 years, the incidence of the primary endpoint event was significantly lower in the beta-blocker group than in the no beta-blocker group (14.2 % vs. 16.3 %; hazard ratio [HR] 0.85; 95 % confidence interval [CI] 0.75 to 0.98; p=0.027). All-cause mortality occurred in 4.2 % and 4.4 % of patients on beta-blocker therapy and no-beta blocker therapy, respectively (HR 0.94; 95 % CI 0.73 to 1.21), while a new MI occurred in 5.0 % and 6.7 % of patients, respectively (HR 0.73; 95 % CI 0.59 to 0.92). There were no apparent differences in the risk of heart failure, malignant ventricular arrhythmias, unplanned coronary revascularisation or ischaemic stroke between patients who received beta-blockers and those who did not, but the statistical power for these individual outcomes was limited.

Although not powered to address the subgroup of patients with mildly reduced LVEF (40−49 %), the HR for the primary endpoint was 0.82 (95 % CI 0.65 to 1.02) among 854 patients. A meta-analysis of data from patients with mildly reduced LVEF (40−49 %) from four trials, including Betami and Danblock, were presented at the same Hot Line session.

Regarding safety, a composite of all-cause mortality, MI, heart failure or malignant ventricular arrhythmia at 30 days occurred in 0.8 % of patients in the beta-blocker group and 1.1 % in the no beta-blocker group. Serious adverse events appeared similarly low between the groups.

Summarizing the findings, Principal Co-Investigator, Professor Eva Prescott from Copenhagen University Hospital – Bispebjerg and Frederiksberg, Denmark, said: “Long-term beta-blocker therapy reduced the composite of all-cause mortality and major adverse cardiovascular events in this patient population, with a notable decrease in the incidence of new MI. Our findings suggest that, despite advances in contemporary MI treatment, the beneficial effects of beta-blocker therapy remain clinically relevant, even in patients without reduced LVEF or heart failure. However, the results must be considered alongside other recent and ongoing trials of beta-blocker therapy after MI to determine their implications for clinical practice.”

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