Recent results obtained from large clinical trials demonstrate that long-term administration of
beta-adrenergic antagonists to patients following
myocardial infarction reduces the incidence of death for as long as two years. Therefore, it has been recommended that, in the absence of
contraindications, all patients be given beta antagonists after
infarction. A review of the literature regarding prognosis after
infarction demonstrates that patients who have had only one
infarction and who have good ventricular function, no complex ectopy, no angina, and negative results of stress testing have a mortality rate no greater than 0.6 percent per year. For a person in this category, the probability that beta blockade will preclude death is exceedingly low (approximately 1 in 700). Both the commonly described side effects, as well as the recent observation that
beta-adrenergic antagonists lower the concentration of serum
high-density lipoproteins, potentially reducing the protection against
atherosclerosis thought to be conferred by
high-density lipoproteins, suggest that it may be unwise to use beta antagonists in patients who have a very low probability of benefit.