Beta blockers, the standard treatment after a heart attack, may offer no benefit for heart attack patients and women can have worse outcomes

2025-08-30

(Press-News.org) Beta blockers—drugs commonly prescribed for a range of cardiac conditions, including heart attacks—provide no clinical benefit for patients who have had an uncomplicated myocardial infarction with preserved heart function. Beta blockers have been the standard treatment for these patients for 40 years.

This is a breakthrough discovery from the “REBOOT Trial” with senior investigator Valentin Fuster, MD, PhD, President of Mount Sinai Fuster Heart Hospital and General Director of Spain’s Centro Nacional de Investigaciones Cardiovasculares (CNIC). The study results, which could overturn a standard treatment paradigm, were presented on Saturday, August 30, during a “Hot Line” session at the European Society of Cardiology Congress in Madrid, and simultaneously published in The New England Journal of Medicine.

Additionally, a REBOOT substudy, published Saturday, August 30, in the European Heart Journal, shows that women treated with beta blockers had a higher risk of death, heart attack, or hospitalization for heart failure compared to women not receiving the drug. Men did not have this increased risk.

“This trial will reshape all international clinical guidelines. It joins other previous landmark trials led by CNIC and Mount Sinai—such as SECURE with the polypill and DapaTAVI, with SLT2 inhibition associated to TAVI—that have already transformed some global approaches to cardiovascular disease,” says Dr. Fuster.

The SECURE trial showed a polypill, a single pill that that combines three medications - which contains aspirin, ramipril, and atorvastatin – reduces cardiovascular events by 33 percent in patients treated with this after a heart attack. The DapaTAVI trial showed both dapagliflozin and the related medication empagliflozin - drugs used to treat diabetes- improves the prognosis of patients with aortic stenosis treated by transcatheter aortic valve implantation.

“REBOOT will change clinical practice worldwide,” says Principal Investigator Borja Ibáñez, MD, CNIC’s Scientific Director, who presented the results. “Currently, more than 80 percent of patients with uncomplicated myocardial infarction are discharged on beta blockers. The REBOOT findings represent one of the most significant advances in heart attack treatment in decades.”

Although generally considered safe, beta blockers can cause side effects such as fatigue, bradycardia (low heart rate), and sexual dysfunction. For more than 40 years, beta blockers have been prescribed as a standard treatment after a heart attack, but their benefit in the context of modern treatments was unproven. The REBOOT trial, is the largest clinical trial on this subject. The international study was coordinated by CNIC in collaboration with the Mario Negri Institute for Pharmacological Research in Milan.

Researchers enrolled 8,505 patients across 109 hospitals in Spain and Italy. Participants were randomly assigned to receive or not receive beta blockers after hospital discharge. All patients otherwise received the current standard of care and were followed for a median of nearly four years. The results showed no significant differences between the two groups in rates of death, recurrent heart attack, or hospitalization for heart failure.

A REBOOT subgroup analysis found that women treated with beta blockers experienced more adverse events. Results show women treated with beta-blockers had a 2.7 percent higher absolute risk of mortality compared to those not treated with beta-blockers during the 3.7 years of follow-up of the study. The elevated risk when treated with beta-blockers was restricted to women with a complete normal cardiac function after a heart attack (left ventricular ejection fraction of 50 percent or higher). Those with a mild deterioration in cardiac function did not have an excess risk of adverse outcomes when treated with beta-blockers.

“After a heart attack, patients are typically prescribed multiple medications, which can make adherence difficult,” explains Dr. Ibáñez. “Beta blockers were added to standard treatment early on because they significantly reduced mortality at the time. Their benefits were linked to reduced cardiac oxygen demand and arrhythmia prevention. But therapies have evolved. Today, occluded coronary arteries are reopened rapidly and systematically, drastically lowering the risk of serious complications such as arrhythmias. In this new context—where the extent of heart damage is smaller—the need for beta blockers is unclear. While we often test new drugs, it's much less common to rigorously question the continued need for older treatments.”

That was the motivation behind REBOOT.

“The trial was designed to optimize heart attack care based on solid scientific evidence and without commercial interests. These results will help streamline treatment, reduce side effects, and improve quality of life for thousands of patients every year,” Dr. Ibanez adds.

REBOOT was conducted without pharmaceutical industry funding.

Mount Sinai Is a World Leader in Cardiology and Heart Surgery

Mount Sinai Fuster Heart Hospital at The Mount Sinai Hospital ranks No. 2 nationally for cardiology, heart, and vascular surgery, according to U.S. News & World Report®. It also ranks No. 1 in New York and No. 6 globally according to Newsweek’s “The World’s Best Specialized Hospitals.”

It is part of Mount Sinai Health System, which is New York City's largest academic medical system, encompassing seven hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. We advance medicine and health through unrivaled education and translational research and discovery to deliver care that is the safest, highest-quality, most accessible and equitable, and the best value of any health system in the nation. The Health System includes approximately 9,000 primary and specialty care physicians; 10 free-standing joint-venture centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 48 multidisciplinary research, educational, and clinical institutes. Hospitals within the Health System are consistently ranked by Newsweek’s® “The World’s Best Smart Hospitals” and by U.S. News & World Report's® “Best Hospitals” and “Best Children’s Hospitals.” The Mount Sinai Hospital is on the U.S. News & World Report's® “Best Hospitals” Honor Roll for 2025-2026.

For more information, visit https://www.mountsinai.org or find Mount Sinai on Facebook, Instagram, LinkedIn, X, and YouTube.

About the CNIC

The CNIC is a center of the Carlos III Health Institute (ISCIII), executive agency of the Spanish Ministry of Science, Innovation, and Universities. Directed by Dr. Valentín Fuster, the CNIC is dedicated to cardiovascular research and the translation of the knowledge gained into real benefits for patients. The CNIC has been recognized by the Spanish government as a Severo Ochoa center of excellence (award CEX2020-001041-S, funded by MICIN/AEI/10.13039/501100011033). The center is financed through a pioneering public-private partnership between the government (through the ISCIII) and the Pro-CNIC Foundation, which brings together 11 of the most important Spanish private companies.

###

END

ELSE PRESS RELEASES FROM THIS DATE:

High Mountain Asia’s shrinking glaciers linked to monsoon changes

2025-08-29

Glaciers across High Mountain Asia are losing more than 22 gigatons of ice per year—the equivalent to nearly 9 million Olympic swimming pools, according to research from the University of Utah and Virginia Tech. The impact of a warming climate on glacial loss is undisputed—this new study provides the first evidence that seasonal shifts in rainfall and snowfall patterns, particularly of the South Asian monsoons, are also exacerbating glacier melting across the region. “These findings highlight that glaciers dominated by the South Asian monsoons, such as the Central Himalaya, ...

All DRII-ed up: How do plants recover after drought?

2025-08-29

LA JOLLA (August 29, 2025)—A plant’s number one priority is to grow—a feat that demands sunlight, nutrients, and water. If just one of these three inputs is missing, like water in a drought, growth halts. You might then think that at the end of that drought, the plant would jump right back into growing. Instead, its priorities shift. Salk plant biologists used advanced single-cell and spatial transcriptomic techniques to look closely at how a small, flowering plant called Arabidopsis thaliana recovers after drought. They discovered that immunity became the plant’s number one priority during this ...

Research on stigma says to just ‘shake it off’

2025-08-29

The stereotypical employee may be at a desk in front of a computer screen working a nine-to-five, but for many employees, the work day is filled with manual labor, hazardous environments and late-night shifts. Your local garbage collector, for example, is someone with a job that society might consider “dirty,” both literally and socially. Scott Dust, PhD, professor in the management department at the University of Cincinnati Carl H. Lindner College of Business, worked with doctoral candidates Sodiq Babatunde and Ben Fagan to analyze the impact of stress and ...

Scientists track lightning “pollution” in real time using NASA satellite

2025-08-29

Picture this: You’re stuck in traffic on a summer afternoon, checking the weather app on your phone as dark storm clouds roll in. You might think about power outages or possible flooding, but you probably don’t think about how every lightning bolt that flashes across the sky also emits a gas, nitrogen oxide (NO), that is also emitted in the exhaust from your car’s engine. Yet, that’s exactly what occurs during a thunderstorm. For the first time, scientists from the University of Maryland were able to detect lightning and its impact on air quality using high-frequency ...

Millions of women rely on contraceptives, but new Rice study shows they may do more than just prevent pregnancy

2025-08-29

Hormonal birth control is a fact of life for millions of women. In the U.S. alone, more than 60 million women of reproductive age have used contraceptives according to the Centers for Disease Control and Prevention, most often to prevent pregnancy but also to manage conditions such as endometriosis, polycystic ovary syndrome and irregular cycles. And as many women will attest, these drugs can affect more than the body. Mood changes, weight fluctuations and emotional ups and downs are common stories women ...

Hot days make for icy weather, Philippine study finds

2025-08-29

The Philippines, like other tropical countries, is known more for its balmy climate than for hailstorms. But a new Philippine study—the first of its kind—has found that the country’s hottest days are, in fact, more likely to produce hail. Hailstorms are so few and far between in the Philippines that, even in an age of pervasive social media updates, they are still met with amazement and astonishment. “Most people are surprised when hail happens because it is relatively rare in the Philippines,” ...

Roxana Mehran, MD, receives the most prestigious award given by the European Society of Cardiology

2025-08-29

The European Society of Cardiology (ESC) has selected Roxana Mehran, MD, Director of Interventional Cardiovascular Research and Clinical Trials at the Zena and Michael A. Wiener Cardiovascular Institute at the Icahn School of Medicine at Mount Sinai, as a winner of the organization’s top honor. Dr. Mehran was presented with the “ESC Gold Medal” during a special ceremony at the ESC Congress in Madrid on Friday, August 29. The ESC Gold Medal recognizes exceptional scientists for their contributions to cardiovascular ...

World's first clinical trial showing lubiprostone aids kidney function

2025-08-29

Chronic kidney disease (CKD) is a major health issue worldwide. Many patients end up requiring regular dialysis to avoid kidney failure and stay alive. Despite the severity of the condition, there are currently no drugs available that improve kidney function. A research group led by Tohoku University Graduate School of Medicine’s Professor Takaaki Abe has found a remarkable solution to treat patients with CKD by co-opting a drug typically used for constipation. This is the first time that this drug (lubiprostone) was shown to prevent the decline of renal function in patients with ...

Capturing language change through the genes

2025-08-29

Throughout human history, there have been many instances where two populations came into contact – especially in the past few thousand years because of large-scale migrations as a consequence of conquests, colonialization, and, more recently, globalization. During these encounters, not only did populations exchange genetic material, but also cultural elements. When populations interact, they may borrow technologies, beliefs, practices, and also, crucially, aspects of language. With this, sounds, words or grammatical patterns can be exchanged ...

Public trust in elections increases with clear facts

2025-08-29

With control of Congress and a check on the Trump administration at issue in the 2026 midterm elections, the upcoming election cycle may again see claims of voter fraud. But warning voters beforehand that there may be false claims about the election, and providing them with information on election security measures through "prebunking," can increase confidence in the results and decrease beliefs in voter fraud, according to a new study published in Science Advances. "Prebunking is effective because it provides people with novel facts about how elections are ...

LAST 30 PRESS RELEASES:

Heatwaves linked to rise in sleep apnoea cases in Europe

Down‑top strategy engineered large‑scale fluorographene/PBO nanofibers composite papers with excellent wave‑transparent performance and thermal conductivity

World Health Organization’s priorities shaped by its reliance on grants from donor organisations such as the Gates Foundation

Dr. Loren Miller presents oral late breaker at IDWeek 2025 of a first-of-its-kind clinical trial that shows efficacy of bacteriophage therapy for Staphylococcus aureus bacteremia