For many years, doctors have been told that patients who suffered an acute myocardial infarction, a heart attack, were all to be prescribed three drugs when they are released from the hospital:
Those drugs are:
1. Aspirin
2. A beta blocker
3. A statin
The reasons for these drugs are each unique, but they overlap in their most Important function.
Aspirin is a “blood thinner.” It functions by inhibiting platelets, the cells which initiate blood clot formation. Blood clots form in areas of an artery that are damaged, or abraded, leading the formation of an arteriosclerotic plaque. Aspirin also has an anti-inflammatory effect, and inflammation is the central process that causes arteries to become arteriosclerotic.
Beta Blockers slow the heart rate and reduce the force of pumping of the heart. They lower arterial resistance so the heart doesn’t have to work as hard as it would otherwise. Beta blockers relax the heart, reduce its work load and allow the damaged heart muscle to heal.
Statin drugs reduce LDL and Total Cholesterol lessening the chances of arteriosclerosis. They also have anti-inflammatory properties that inhibit plaque formation. Platelets are less numerous, and less sticky, and lower cholesterol levels reduce the chances of cholesterol adhering to platelets and forming plaques.
Beta blockers, such as metoprolol, were recommended to be taken for life. They are benign drugs, as long as you’re not asthmatic, and were thought to benefit post MI patients’ longevity, quality of life, and chances of additional cardiovascular events.
A study by French investigators at 49 sites, however, showed that patients on long term beta blockers did have “fewer hospitalizations for cardiovascular events, but had no fewer actual heart attacks, strokes, or cardiovascular deaths.” There was also no difference in quality of life between groups who did and did not take beta blockers, either. These unanticipated less-than-impressive results did not change the recommendation favoring continued beta blocker use.
Dr. G’s Opinion: If you have had a heart attack, stay on Beta Blockers, statins and aspirin. This combination post MI is almost harmless and benefits cardiac patients greatly. I think in actuality, there is more benefit from this combination of drugs than was appreciated by this study.
Reference: Ebell MH. “Continued beta blocker use after acute MI reduces hospitalizations but not cardiovascular death, Acute MI, or Stroke” Am Fam Phys 2025 April;111(4):376.
