A widely prescribed class of heart drugs, beta-blockers, long considered standard treatment after a heart attack, may not help most patients — and could even increase health risks for some women, according to new research.
Key Findings
The studies, published in the European Heart Journal and The New England Journal of Medicine, revealed that women with normal heart function after a heart attack were nearly three times more likely to die if treated with beta-blockers compared with those who did not take the drugs. They were also more likely to suffer another heart attack or be hospitalized for heart failure.
By contrast, the same risk was not seen in men. The results suggest that sex-specific guidelines may be urgently needed for cardiovascular treatment.
“This will reshape all international clinical guidelines,” said Dr. Valentin Fuster, president of Mount Sinai Fuster Heart Hospital and senior author of the study.
When Beta-Blockers Still Help
The danger applied only to patients with a left ventricular ejection fraction above 50%, which indicates normal heart pumping function. For those with more severely reduced heart function (below 40%), beta-blockers remain the standard of care because of their proven ability to prevent dangerous arrhythmias and reduce risk of sudden death.
A separate meta-analysis published in The Lancet also found benefits for patients with mildly reduced function (40–50%), showing about a 25% reduction in repeat heart attacks, heart failure, or death.
Why Women Respond Differently
Experts say it’s not surprising that women may react differently to the drugs. “Women often have smaller hearts and are more sensitive to blood pressure medications,” said Dr. Andrew Freeman of National Jewish Health, who was not involved in the study. “Biology, body size, and even how heart disease presents in women versus men can change how drugs affect outcomes.”
Historically, most heart research focused on men, leaving gaps in understanding women’s cardiovascular health. Men typically develop blockages in large arteries and show classic symptoms like chest pain, while women often have disease in smaller vessels and present with subtler symptoms such as back pain or indigestion.
A 40-Year Standard Challenged
Beta-blockers have been used as a first-line therapy for heart attack patients for over four decades. However, medical advances such as immediate stenting and modern blood thinners mean many survivors now recover with near-normal heart function, raising questions about whether beta-blockers are still necessary in all cases.
Despite this, around 80% of heart attack patients worldwide are still prescribed the drugs.
“The medical community often tests new drugs but rarely questions the continued need for old ones,” said Dr. Borja Ibáñez, lead author of the trial. “These results show it’s time to rethink that practice.”
Side Effects to Consider
Beyond the newly uncovered risks, beta-blockers are known to cause side effects such as fatigue, mood swings, low heart rate, low blood pressure, and erectile dysfunction.
Doctors now say treatment decisions should be individualized, especially for women with preserved heart function, until clinical guidelines catch up with the new evidence.
Source: CNN Health | Image Source: Getty | Image Credit: Respective Owner
