Warns of higher risks for women

A groundbreaking study has raised serious questions about the long-standing use of beta blockers as routine treatment after heart attacks, suggesting the drugs may provide no benefit for patients with uncomplicated myocardial infarction and could even increase health risks for women.

For more than four decades, beta blockers have been a standard part of post-heart attack care, prescribed to reduce strain on the heart and prevent further complications. However, new findings presented at the European Society of Cardiology Congress in Madrid—and published simultaneously in The New England Journal of Medicine and the European Heart Journal—suggest it is time to reconsider this practice.

The study, involving 8,505 patients across 109 hospitals in Spain and Italy, found no significant difference in rates of death, recurrent heart attack, or hospitalisation for heart failure between patients prescribed beta blockers and those who were not. All participants received standard care otherwise and were followed for nearly four years.

Crucially, a subgroup analysis revealed troubling results for women. Female patients who took beta blockers showed a 2.7 per cent higher absolute risk of mortality compared to those who did not, alongside increased risks of recurrent heart attack or hospitalisation for heart failure. No similar elevated risks were observed among men.

“The study will reshape all international clinical guidelines,” said senior investigator Valentin Fuster, President of Mount Sinai Fuster Heart Hospital. “Currently, more than 80 per cent of patients with uncomplicated myocardial infarction are discharged on beta blockers. These findings represent one of the most significant advances in heart attack treatment in decades.”

Principal investigator Borja Ibáñez, Scientific Director at Spain’s Centro Nacional de Investigaciones Cardiovasculares (CNIC), stressed the urgent need for change. “The data clearly indicate that beta blockers offer no benefit in these cases, and in women, they may even be harmful,” he said.

While beta blockers are generally considered safe, they are known to cause side effects such as fatigue, low heart rate (bradycardia), and sexual dysfunction. This new evidence highlights the need for sex-specific approaches in cardiovascular care, challenging a one-size-fits-all model that has persisted for years. With mounting evidence, cardiologists worldwide are now expected to revisit treatment protocols, potentially marking a paradigm shift in post-heart attack care.