Beta-Blockers Reduce Heart Attack Size By Limiting Inflammation Interview with:

Borja Ibáñez MD Spanish National Centre for Cardiovascular Research Madrid

Dr. Ibáñez

Borja Ibáñez MD
Spanish National Centre for Cardiovascular Research
Madrid What is the background for this study? What are the main findings?

Response: Acute myocardial infarction (heart attack) is a severe condition responsible for thousands of deaths every year and with important long-term consequences for survivors. Best treatment for acute myocardial infarction is a rapid coronary reperfusion.

Upon reperfusion, all inflammatory cells and mediators accumulated in the circulation during the infarction process, enter into the myocardium and causes an extra damage to the heart. Activated neutrophils play a critical role in this damage occurring upon reperfusion. The final size of infarction is the main determinant for mortality and long-term morbidity. The possibility of limiting the extent of infarcted tissue is of paramount importance.

Betablockers have been used in patients for more than 4 decades, mainly to treat arrhythmias and high blood pressure. Recently the same group of investigators demonstrated that the very early administration (i.e. during ambulance transfer to the hospital) of the betablocker “metoprolol” was able to reduce the size of infarction in patients. The mechanism by which metoprolol was protective in patients suffering a myocardial infarction was unknown. What should readers take away from your report?

Response: In this study, authors demonstrate that during a myocardial infarction, metoprolol has a direct effect on neutrophils precluding their inflammatory activity. By “stunning” neutrophils, these cannot exert an injury to the heart upon reperfusion and the final result is that the size of infarction is significantly reduced.

This study shows for the very first time that betablockers have a potent inhibitory effect on activated neutrophils. Until now, the effect of these drugs were thought to occur by targeting the cardiac cells only. The effect of metoprolol on a different compartment (circulating cells) opens a wide window of new applications. In other conditions in which activated neutrophils play a deleterious role (e.g. sepsis), metoprolol might be beneficial. What recommendations do you have for future research as a result of this study?

Response: Future studies should test the effect of metoprolol on different diseases in which activated neutrophils play a significant negative role.

In parallel, larger clinical trials in patients suffering an acute myocardial infarction should be undertaken to show that the infarct limiting effect already known translates into reduced long term mortality and alleviated disability of infarction survivors. Is there anything else you would like to add?

Response: This study represents an example of multidisciplinary translational research, combining basic research and clinical studies to decipher a mechanism of a known drug with important clinical implications. Thank you for your contribution to the community.


Neutrophil stunning by metoprolol reduces infarct size
Jaime García-Prieto, Rocío Villena-Gutiérrez, Mónica Gómez, Esther Bernardo, Andrés Pun-García, Inés García-Lunar, Georgiana Crainiciuc, Rodrigo Fernández-Jiménez, Vinatha Sreeramkumar, Rafael Bourio-Martínez, José M García-Ruiz, Alfonso Serrano del Valle, David Sanz-Rosa, Gonzalo Pizarro, Antonio Fernández-Ortiz, Andrés Hidalgo, Valentín Fuster & Borja Ibanez
Nature Communications 8, Article number: 14780 (2017)

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Last Updated on April 18, 2017 by Marie Benz MD FAAD