Beta-blockers and sudden cardiac death.

OBJECTIVES

To 1) consider the problem of sudden death from heart disease and the role of beta-blockers and other agents in preventing sudden death and 2) review perceived problems with beta-blocker therapy, such as effects on blood lipids, complications in diabetes, and adverse effects on heart failure and quality of life.

DATA SOURCES

MEDLINE and EMBASE searches done from July 1994 on, and recognized texts.

STUDY SELECTION

More than 400 original and review articles were evaluated, of which the most relevant were selected.

DATA EXTRACTION

Data were extracted and reviewed by two authors. Accuracy was confirmed, when necessary, by the other authors.

DATA SYNTHESIS

Of all of the therapies currently available for the prevention of sudden cardiac death, none is more established or more effective than beta-blockers. Indeed, the evidence that beta-blockers have a cardioprotective effect is compelling. They probably reduce the rate of atheroma formation; they reduce the risk for ventricular fibrillation in animal models of myocardial ischemia; they appear to reduce cardiac mortality in primary prevention trials; and they reduce mortality, particularly from sudden death, in patients who have had infarction. Moreover, withholding beta-blockers because of problems perceived to be associated with them is usually not warranted and may frequently prevent their use in those who will benefit most from them.

CONCLUSION

Clinicians should reappraise the evidence for the significant effect of beta-blockers on morbidity and mortality, and they should recognize the importance of initiating and maintaining beta-blocker therapy when the less well-informed might suggest otherwise.