In a new study, researchers found that a drug costing less than 2 euros per dose could reduce the long term consequences of a heart attack, benefitting millions of patients.
Metoprolol, a member of the beta-blocker class of drugs that has been in use for more than 40 years, has been found to have unique heart-protective features.
The researchers found that the heart-protective effect of metoprolol during a heart attack is not shared by other beta-blockers.
The research was conducted by a team at the Centro Nacional de Investigaciones Cardiovasculares (CNIC) and elsewhere.
A heart attack is one of the main manifestations of heart disease and is the leading cause of death in the world. In Spain, more than 70 000 people have a heart attack every year.
Current treatment guidelines recommend early use of beta-blockers to patients with symptoms of infarction but do not distinguish between the different drugs in this class.
A previous study showed that the use of metoprolol very early during a heart attack limits damage to the heart and reduces long term consequences.
Four years later, in 2017, the same research team showed how and why this cheap and simple therapeutic strategy is so efficient.
The researchers showed that the heart-protective potential of metoprolol lies in its ability to block the action of neutrophils—inflammatory cells activated during infection to eliminate pathogens—preventing them from entering the infarcted heart tissue.
Now, in the new study, the team found that metoprolol’s heart-protective properties are not shared by other beta-blockers and are thus not a class effect.
They found that neutrophils, as well as protecting against infection, can become hyperactivated in other situations, such as during a heart attack, when they can cause significant additional injury to the heart.
Metoprolol is able to limit this hyperactivation, thereby preventing inflammatory damage associated with the heart attack.
The study also assessed the effects of different beta-blockers in other models of inflammatory disease, like lung damage and peritonitis.
They found the drug metoprolol was the only beta-blocker able to limit the organ damage inflicted by hyperactivated neutrophils.
These findings could have an impact on the treatment of diseases in which injury is linked to neutrophil hyperactivation, including sepsis and possibly even COVID-19.
The authors conclude that metoprolol should be the beta-blocker of choice in clinical practice.
If these results are confirmed in future clinical studies, this would herald a change in the clinical guidelines for this devastating disease, placing metoproplol, and not other beta-blockers, as the drug of choice for patients suffering a heart attack.
The low cost of metoprolol, at less than 2 euros for an acute dose, brings additional value to this discovery.
One author of the study is Dr. Borja Ibáñez, the head of Clinical Research at the CNIC.
The study is published in The European Heart Journal.
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