Beta-blockers equally effective for blacks, whites with HFrEF
A study published May 8 in the Journal of the American Heart Association suggests black and white patients with heart failure with reduced ejection fraction (HFrEF) derive similar benefit from beta-blockers, despite conflicting previous reports.
Exposure to beta-blockers was calculated based on pharmacy claims and was found to be associated with a 44 percent reduction in all-cause mortality among blacks and a 52 percent reduction in mortality among whites over a median follow-up of three years. Using multivariable adjustment, the researchers assessed the effectiveness of the medications on 575 self-reported blacks and 547 self-reported whites from the Henry Ford Health System in Detroit.
Notably, they also put each patient through genetic testing to establish their proportion of African ancestry; self-reported whites averaged 1 percent African ancestry, while self-reported blacks averaged 13 percent European ancestry. Even with this genetic heterogeneity, beta-blockers were found to be similarly effective for both races.
“The fact that we found similar reductions in mortality stratified by self‐reported race (representative of biological and sociocultural effects) and genetic ancestry (representative of only biological effects) is reassuring that beta‐blockers are equally effective in white and black patients,” wrote lead author Jasmin A. Luzum, PharmD, PhD, and colleagues.
The authors said there has been confusion over whether beta-blockers were similarly helpful to black and white HFrEF patients because the landmark trials evaluating the drugs included almost exclusively whites, and some observational data sets have suggested less benefit among black individuals.
This observational analysis based on self-reports of race and genetic testing may be the best available way to assess the treatments by race, the authors said, because another randomized trial would likely be deemed unethical now that efficacy has been established.
“The availability of genetic ancestry can help differentiate true inherited differences versus the wide range of environmental factors that are associated with self‐identified race, such as socioeconomic status, diet and healthcare quality and accessibility, all of which can make attempts to understand the underlying cause of race disparities in health outcomes very difficult,” they wrote. “It is important to interrogate the role of genetic ancestry because socioeconomic factors do not fully explain the critical race disparities in heart failure outcomes, and to try to quantify potential genetic and biological effects.”
Luzum et al.’s study defined HFrEF as ejection fraction below 50 percent, but a sensitivity analysis among patients with ejection fraction below 40 percent also demonstrated similar efficacy for the drugs regardless of race.
“These data lend further credence to current guidelines that recommend beta‐blocker use in all HFrEF patients, reassuring patients and providers that black HFrEF patients are likely deriving similar benefit from beta‐blocker treatment,” the authors wrote. “These findings are not suggestive of genetic mechanisms meaningfully impacting beta‐blocker effectiveness relative to race.”
Daniel joined TriMed’s Chicago editorial team in 2017 as a Cardiovascular Business writer. He previously worked as a writer for daily newspapers in North Dakota and Indiana.