Statins Beta blockers

Because the above trials showed a >50% relative reduction in total mortality with ICD therapy, MADIT II used broader entry criteria for primary prevention of SCD, removing the criteria for NSVT and EPS 1,232 patients with a history of MI > 30 days prior and an EF < 30% were randomized to conventional therapy or ICD implantation [10]. Conventional therapy was comparable in both arms and included a high rate of use of beta blockers, angiotensin-converting enzyme inhibitors, and statins (over two thirds for all medications in both arms). The trial was stopped early at 20 months because the relative reduction in total mortality... 

In a post-MI population of 700 patients in which 97% took beta-blockers, SAECG was found to have a low PPV of 13% but a NPV of 97% for SCD (60). However, these results were not reproduced in another trial of patients also on contemporary therapy, including statins and angiotensin-converting enzyme inhibitors, where SAECG did not predict arrhythmic events or death (61). 

Beta-blocker (or calcium channel blocker if BB contraindicated) Statin... 

Atenolol - beta blocker hypertension, angina, arrhythmia Atomoxetine - CNS stimulant treatment of ADHD Atorvastatin - statin lipid lowering drug Atovaquone - antimalarial... 

Other signs of hope in large part owing to the availability of better drugs, are all around. Patients now live for years and even decades after organ transplants, something formerly not possible because of rejection. Death rates due to heart disease are now less than half of what they were in 1950, and the death rate due to stroke is down by almost three-quarters in that same time period. Drugs like beta blockers, statins, and tPA are major contributors to these improvements. 

Propranolol doe not cause any clinically relevant changes to the pharmacokinetics of fluvastatin, lovastatin or pravastatin. In clinical studies, the safety and efficacy of statins were not altered by the concurrent use of beta blockers as a class. 

No special precautions would seem to be necessary if beta blockers are given concurrently with statins. 

The MADIT II trial addressed some of the issues raised by the MADIT. The MADIT II trial evaluated patients with ischemic cardiomyopathy (history of myocardial infarction > 1 month before entry). New York Heart Association Functional Class I-III congestive heart failure, and left ventricular ejection fraction < 0.30 (documented within 3 months), with or without ventricular ectopy. The study enrolled 1,232 patients to assess if an ICD improve total mortality compared to optimal therapy alone. No Holter or electrophysiology test criteria were required for enrollment. Optimal medical therapy included angiotensin-converting-enzyme inhibitors, beta-blockers, diuretics, and lipidlowering statin drugs (172). 

Responsibilities for management of chronic and preoperative medication need to be clearly defined and communicated between all involved caregivers. Timely prescription (e.g. treatment of preoperative anemia), reliable continuation (e.g. beta-blockers, aspirin, statins) [2], timely discontinuation (e.g. metformin, platelet inhibitors, new oral anticoagulants), and effective bridging (insulin, unfractionated heparin) of preoperative medications increase patient safety by reducing risks of myocardial ischemia, bleeding and transfusion, and help to avoid case cancellations. 

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