Medical News Today (MNT)Beta-blockers May Be Harmful for Women with Some Heart Conditions

The NEJM-published REDUCE-AMI trial and European Heart Journal sex-specific analysis challenge routine beta-blocker use following myocardial infarction with preserved ejection fraction (LVEF >40%). In 8,438 participants followed for 3.7 years, beta-blockers showed no benefit for the composite endpoint of death, recurrent MI, or heart failure hospitalization. Critically, subgroup analysis revealed beta-blockers may increase mortality risk in women, particularly those with preserved LVEF and higher dosing regimens.

🔬 Key Clinical Considerations

• Sex-specific outcomes: Women on beta-blockers demonstrated 45% higher relative risk for the primary composite endpoint, driven primarily by increased cardiac mortality—a finding not observed in men with similar cardiac function profiles.
• Preserved LVEF vulnerability: The harmful effect in women appeared confined to those with preserved left ventricular ejection fraction and those receiving higher beta-blocker doses, suggesting a sex-based pharmacological response differential.
• Sample size limitations: Only one in five trial participants were women, with female participants being older and having more comorbidities than male counterparts, potentially limiting generalizability to diverse patient populations.
• Treatment equity concerns: Women received fewer guideline-based therapies overall, highlighting systematic disparities in post-MI cardiovascular care that may compound medication-related risks in female patients.
• Clinical equipoise zone: For mildly reduced ejection fraction (LVEF 40-49%), event rates favored beta-blockers in both sexes, though small sample sizes prevent definitive conclusions about benefit in this intermediate group.

💊 Clinical Practice Impact

• Patient Communication: OBGYN providers managing pregnant or postpartum patients with cardiac history should counsel women about emerging evidence of sex-specific beta-blocker risks, particularly when transitioning cardiac care between specialties or managing peripartum cardiomyopathy recovery.
• Practice Integration: Review beta-blocker prescriptions in female patients with preserved cardiac function post-MI, coordinating with cardiology to assess risk-benefit ratio and consider dose reduction or alternative therapies, especially in reproductive-age women planning pregnancy.
• Risk Management: Document discussions about sex-specific cardiovascular medication outcomes when co-managing patients with cardiology, particularly for women with preserved LVEF on high-dose beta-blockers who may benefit from treatment reevaluation.
• Action Items: Flag female patients on beta-blockers post-MI for cardiac function assessment; ensure LVEF is documented and current; coordinate with cardiology for patients with preserved function (>50%) to discuss deprescribing strategies or dose optimization.
• Reproductive Planning: Consider beta-blocker teratogenicity profiles and hemodynamic effects when counseling reproductive-age women with cardiac history, as medication adjustments may be necessary both before conception and during pregnancy when cardiac demands change.

HCN Medical Memo
OBGYN providers should proactively identify women on beta-blockers with preserved cardiac function and facilitate collaborative cardiac reassessment. Integration of sex-specific cardiovascular risk assessment into routine gynecologic and obstetric care may identify patients requiring medication optimization, particularly when planning pregnancy or managing peripartum cardiac complications.

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