Doctors find new use for decades-old drug Study shows beta-blocker could boost survival 35% for heart-failure patients

November 11, 1998|By Diana K. Sugg | Diana K. Sugg,SUN STAFF

A drug that doctors feared would hurt heart-failure patients has turned out to be the very medicine that might save their lives.

In preliminary results reported yesterday at the American Heart Association meeting, researchers from the University of zTC Maryland Medical Center found that adding an old drug -- the beta-blocker metoprolol -- to the treatment of heart-failure patients increased survival by about 35 percent.

The evidence was so strong that physicians overseeing the international study of nearly 4,000 patients had to stop it almost three years early.

"This was a dramatic benefit, even more than we expected," said Dr. Stephen S. Gottlieb, a director of Maryland's heart-failure service and co-director of the U.S. part of the study. "It's the most common disease that causes hospitalization. That's a lot of people who can benefit."

Heart failure stems from heart attacks, alcohol use, high blood pressure and possibly infections. In many cases, doctors don't know what causes it. These patients can function, but because their hearts aren't pumping well, they often find themselves short of breath.

Metoprolol was approved more than 20 years ago and is usually used for patients with high blood pressure and heart attacks.

When first given to patients, the drug might make the heart pump less effectively, Gottlieb said, so physicians had been taught for years that metoprolol should not be used for heart-failure patients.

Recently, though, doctors have started to believe that metoprolol, if given slowly and carefully over a period of weeks, could help these patients by strengthening their hearts in the long term. Gottlieb's study shows that not only can it help patients, it can save their lives.

"It's now time to figure out how to safely give these drugs," Gottlieb said.

In other findings reported at the conference, doctors said that some times, days and seasons are riskier than others for heart attacks, but the explanations may not be as simple as they would seem.

Heart attacks are more common in winter than summer, for instance, but they still occur in Los Angeles, where winters are mild. Researchers speculated that the risky element might be the holiday season -- and the stress and higher alcohol intake it brings -- rather than the chill in the air.

In one study, heart-attack victims had a 20 percent to 40 percent higher risk than usual on Mondays. But it couldn't be simply because it was the first day of the workweek, because a quarter of the 1,500 heart-attack victims in the study were retired. Physicians hypothesized that it wasn't work, but the return to chores and other stressful routines, that made Monday riskier.

The clearest finding, shown in more than 30 studies, is that morning is the riskiest time of day for the heart.

Pub Date: 11/11/98

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