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February 6, 2013

β-Blocker Use for Patients With or at Risk for Coronary Artery Disease—Reply

Author Affiliations

Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

Author Affiliations: New York University School of Medicine, New York, New York (Dr Bangalore; sripalbangalore@gmail.com); Université Paris Diderot, Paris, France (Dr Steg); and VA Boston Healthcare System, Boston, Massachusetts (Dr Bhatt).

JAMA. 2013;309(5):438. doi:10.1001/jama.2012.128872

In Reply: Dr Shang contends that our results are mostly confirmation of a well-known fact that atenolol is ineffective and may not be generalized to other β-blockers such as carvedilol. This statement highlights the discordance between trials and practice and an optimism bias based on perceived benefit of a newer agent assessed by surrogate end points only.

The well-known fact that atenolol is ineffective has not translated into clinical practice—atenolol was the second top generic drug based on retail dollars in 2010.1 The data on β-blocker use in patients without heart failure are based on older agents and as a result, there is no guideline recommendation of a preferred β-blocker.