Antiatherogenic effects of β-adrenergic blocking agents: Theoretical,experimental, and epidemiologic considerations

Theoretical considerations and results from experimental studies in animal models suggest that long-term β-adrenergic blockade should be antiatherogenic. Some of these experimental results indicate that β-blockers could inhibit atherogenesis and thus prevent clinical events independently of any effects on blood pressure through concomitant reductions in heart rate, blood velocity and energy, endothelial permeability to lipoproteins, and the likelihood of plaque rupture. Any such independent inhibition of atherogenesis implies, in turn, that β-blockers might be more desirable than alternative antihypertensive therapies in persons at high risk for atherosclerotic diseases. Results of the three major trials directly comparing β-blockers to diuretics in the primary prevention of coronary heart disease among patients with hyportonsion were largely inconclusive. However, ancillary data from these and other trials are consistent in demonstrating that β-adrenergic blockade is associated with anti-coronary heart disease effects and, thus, is perhaps antiatherogenic. A definitive evaluation of the antiatherogenic effects of β-blockers is not forthcoming because no large clinical trials directly assessing the effect of these drugs on atherosclerosis have been done or are planned.