Low-dose metoprolol CR/XL and fluvastatin slow progression of carotid intima-media thickness - Main results from the beta-blocker cholesterol-lowering asymptomatic plaque study (BCAPS)

Background-Statins reduce cardiovascular events and progression of carotid intima-media thickness (IMT), beta -Blockers are also known to reduce cardi ovascular events, but less is known about their effects on carotid IMT. Methods and Results-We conducted a randomized, double-blind, placebo-contro lled, single-center trial to compare the effects of low-dose metoprolol CR/ XL (25 mg once daily) and fluvastatin (40 mg once daily) on the progression of carotid IMT during 36 months of treatment in 793 subjects who had carot id plaque but no symptoms of carotid artery disease. Changes in mean IMT in the common carotid artery and maximal IMT in the bulb were the main outcom e variables. Death and cardiovascular events were monitored. Progression of IMTmax in the carotid bulb at both 18 and 36 months was reduced by metopro lol CR/XL (-0.058 mm/y; 95% CI, -0.094 to -0.023; P=0.004; and -0.023 mm/y; 95% CI, -0.044 to -0.003; P=0.014, respectively). Incidence of cardiovascu lar events tended to be lower in metoprolol CR/XL-treated patients (5 versu s 13 patients, P=0.055). Rate of IMTmean progression in the common carotid at 36 months was reduced by fluvastatin (-0.009 mm/y; 95% CI, -0.015 to -0. 003; P=0.002), Women in the fluvastatin group had increased frequency of tr ansiently high liver enzymes. Conclusions-This is the first randomized trial to show that a beta -blocker can reduce the rate of progression of carotid IMT in clinically healthy, s ymptom-free subjects with carotid plaque. This suggests that beta -blockers may have a favorable effect on atherosclerosis development.