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A significant new evaluation from the REBOOT (Therapy with Beta-blockers after Myocardial Infarction with out Decreased Ejection Fraction) scientific trial, a global examine coordinated by the Centro Nacional de Investigaciones Cardiovasculares (CNIC), printed within the European Coronary heart Journal has revealed vital sex-specific variations within the results of beta-blockers following coronary heart assaults, elevating questions on long-standing therapy practices.
REBOOT, offered in a Hotline session of the ESC congress in Madrid, is the biggest contemporaneous trial testing the impact of beta-blockers in sufferers who survive myocardial infarction with out a reasonable or extreme deterioration of their cardiac operate (i.e. left ventricular ejection fraction better than 40%). 8,505 sufferers have been included throughout 109 hospitals in Spain and Italy.
Whereas the proportion of girls within the trial was not excessive (one thing frequent in most myocardial infarction trials), the whole variety of ladies is the biggest ever included in a trial testing beta-blockers after infarction, offering excessive energy to the evaluation carried out.
Sufferers have been randomly assigned to obtain beta-blockers—a generally prescribed drug—or no beta-blocker, whereas persevering with to obtain normal post-heart assault care. Sufferers have been adopted for a median of practically 4 years.
The evaluation uncovers notable sex-specific variations: whereas males skilled no profit or danger when handled with beta-blockers, ladies handled with beta-blockers had a major elevated danger of dying, reinfarction, or hospitalization for coronary heart failure in comparison with ladies not receiving the drug.
Ladies handled with beta-blockers had a 2.7% larger absolute danger of mortality than these not handled with beta-blockers throughout the 3.7 years of follow-up of the examine.
The elevated danger when handled with beta-blockers was restricted to ladies with an entire regular cardiac operate after infarction (i.e. left ventricular ejection fraction of fifty% or larger).
These with a gentle deterioration in cardiac operate didn’t have an extra danger of hostile outcomes when handled with beta-blockers.
One other vital discovering from this pre-specified evaluation of the REBOOT trial is that girls presenting with infarction had a worse cardiovascular profile. They have been older, had extra comorbidities (together with larger prevalence of hypertension, diabetes and dyslipidemia), and extra ceaselessly skilled coronary heart assaults with out obstructive coronary arteries (6% vs. 2% in males).
As well as, whereas total prescription charges of secondary prevention interventions have been excessive for all sufferers within the trial, ladies have been much less typically prescribed some guideline-recommended therapies akin to antiplatelets, statins, angiotensin-converting enzyme inhibitors (ACE), angiotensin receptor blockers (ARBs) or cardiac rehabilitation.
Of be aware, total, ladies had a considerably worse prognosis than males (mortality throughout examine period was 4.3% in ladies vs. 3.6% in males).
The Principal Investigator of the REBOOT trial, Dr. Borja Ibáñez, CNIC Scientific Director, heart specialist at Hospital Universitario Fundación Jiménez Díaz, and member of the CIBERCV, says, “These findings confirm previous observational data, but in a rigorous prospective trial: women presenting with infarction have worse cardiovascular profile and, more importantly, have worse prognosis than men. Our data also shows that they respond differently to a commonly prescribed intervention, beta-blockers in this case.”
Xavier Rosselló, scientist at CNIC, heart specialist at College Hospital Son Espases in Mallorca and one other chief of the REBOOT trial emphasizes, “Our findings suggest that a one-size-fits-all approach may not be appropriate and that sex-specific considerations are crucial for cardiovascular interventions prescriptions.”
The REBOOT trial was coordinated by the CNIC, in collaboration with the Mario Negri Institute for Pharmacological Analysis in Milan, Italy. As the biggest unbiased examine of its form, it offers vital insights into how fashionable post-heart assault remedies ought to contemplate affected person intercourse, coronary heart operate, and dosing methods.
“In many cases, prescribing beta-blockers to women after uncomplicated heart attack may do more harm than good,” Dr. Ibáñez added. “Clinicians should carefully weigh the risks and benefits, and consider dose adjustments or alternative therapies when treating female patients.”
The trial’s outcomes underscore the significance of personalizing post-heart assault remedy. By highlighting how sex-specific components affect the protection and effectiveness of generally used medicine, REBOOT may reshape tips and enhance outcomes for ladies worldwide.
Dr. Valentín Fuster, CNIC Common Director, President of Mount Sinai Fuster Coronary heart Hospital, and one other investigator of the REBOOT trial, notes, “Now we have been investigating sex-differences in heart problems for a very long time.
“We already knew that cardiovascular disease presentation is different in women and men, and this study significantly adds to this knowledge by showing that response to medications is not necessarily equal in women and men. This study should spark the much-needed sex-specific approach to cardiovascular disease.”
Extra info:
Borja Ibanez et al, Beta-blockers after myocardial infarction: results based on intercourse within the REBOOT trial, European Coronary heart Journal (2025). DOI: 10.1093/eurheartj/ehaf673
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Centro Nacional de Investigaciones Cardiovasculares
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After a coronary heart assault, ladies proven to have worse prognosis when handled with beta-blockers (2025, August 30)
retrieved 30 August 2025
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