Abstract
Accumulating data from studies in animals and humans indicate that β-blockade has
antiatherosclerotic effects. To date, 2 long-term ultrasound studies provide the strongest
evidence. The Beta-Blocker Cholesterol-Lowering Asymptomatic Plaque Study (BCAPS)
trial reported favorable effects with β-blockade on early stages of atherosclerosis
in patients with carotid plaque but no symptoms of carotid artery disease. Compared
with placebo, metoprolol controlled release/extended release (CR/XL) 25 mg once daily
significantly reduced plaque thickness after 18 months of treatment (net difference
−0.058 mm/year; p <0.001) and at 3 years’ follow-up (net difference −0.023 mm/year;
p = 0.018). The Effects of Long-Term Treatment of Metoprolol CR/XL on Surrogate Variables
for Atherosclerotic Disease (ELVA) trial demonstrated that β-blockers and statins
affect different mechanisms in the atherosclerotic process and have additive beneficial
effects. Patients with hypercholesterolemia were randomized to metoprolol CR/XL 100
mg once daily or placebo once daily and concomitant statin therapy. The metoprolol
CR/XL group had a significantly lower rate of progression of the composite carotid
bulb intima-media thickness (IMT) plus common carotid IMT than the placebo group,
both at 1 year (−0.08 vs −0.01 mm; p = 0.004) and after 3 years’ follow-up (−0.06
vs +0.03 mm; p = 0.011). Several factors may contribute to the mechanism of benefit
in these trials, including reduced sympathetic activity, improved hemodynamic parameters,
and direct effects on the vascular endothelium.
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Article info
Footnotes
☆John Wikstrand, MD, PHD, is Senior Medical Advisor for Clinical Science, Astrazeneca, Mölndal, Sweden. Johannes Hulthe, MD, PHD, is Medical Advisor for Experimental Medicine, Astrazeneca, Mölndal, Sweden.
Identification
Copyright
© 2003 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
