BETA-BLOCKERS AND SUDDEN CARDIAC DEATH

Objectives: To 1) consider the problem of sudden death from heart dise ase and the role of beta-blockers and other agents in preventing sudde n death and 2) review perceived problems with beta-blocker therapy, su ch as effects on blood lipids, complications in diabetes, and adverse effects on heart failure and quality of life. Data Sources: MEDLINE an d EMBASE searches done from July 1994 on, and recognized texts. Study Selection: More than 400 original and review articles were evaluated, of which the most relevant were selected. Data Extraction: Data were e xtracted and reviewed by two authors. Accuracy was confirmed, when nec essary, by the other authors. Data Synthesis: Of all of the therapies currently available for-the prevention of sudden cardiac death, none i s more established or more effective than beta-blockers. Indeed, the e vidence that beta-blockers have a cardioprotective effect is compellin g. They probably reduce the rate of atheroma formation; they reduce th e risk for ventricular fibrillation in animal models of myocardial isc hemia; they appear to reduce cardiac mortality in primary prevention t rials; and they reduce mortality, particularly from sudden death, in p atients who have had infarction. Moreover, withholding beta-blockers b ecause of problems perceived to be associated with them is usually not warranted and may frequently prevent their use in those who will bene fit most from them. Conclusion: Clinicians should reappraise the evide nce for the significant effect of beta-blockers on morbidity and morta lity, and they should recognize the importance of initiating and maint aining beta-blocker therapy when the less well-informed might suggest otherwise.