Beta-Blockers Can Help Make Surgeries Safer

Published by Contra Costa Times

Posted on Sun, April 4, 2004

By Dr. Jeremy Fish

IF AN INEXPENSIVE PILL taken once a day the week before and a few weeks after surgery would make the surgery safer, would you take it? Most people would, especially if the pill is safe with only rare side effects.

But many people don't.

In 1996, Americans had more than 72 million surgical procedures. As our population grows, and new and better surgical procedures become available, even more Americans will have operations. And, as our population ages, more older patients, many with heart disease, will have such operations.

In fact, more than 8 million Americans with coronary artery disease and 27 million more with risk factors for it - such as diabetes, high blood pressure, obesity, high cholesterol and a family history of early onset heart disease - have operations every year in the United States.

Of those, more than 50,000 have a heart attack during or soon after their operation, and nearly 1 million suffer serious heart problems as a result.

Until a few years ago, there was little that could be done to prevent serious heart problems during an operation. To avoid the risk of a heart attack, some patients simply couldn't have the operations they needed or were forced to have coronary bypass surgery or angioplasty before having another type of operation.

Researchers have discovered that a class of commonly used blood pressure medications, called beta-blockers, can dramatically reduce the risk of heart complications during and after many common surgeries, such as hernia repairs, prostate surgery, intestinal disorders, gall bladder removal, cancer surgery and others. In some cases, beta-blockers cut the risk of a heart attack or death in half. Beta-blockers, such as atenolol, metoprolol, and bisoprolol, have long been known to reduce the risk of heart attack and stroke in patients with high blood pressure.

They are also effective for treating heart attacks unrelated to surgery.

Despite strong evidence of their benefit, however, beta-blockers are still not always prescribed before surgery. This may be because some doctors are still unaware of the potential benefits, or because they are reluctant to prescribe a medication with which they are not familiar.

The American College of Cardiologists and American Heart Association guidelines (www.acc.org) now strongly recommend the use of beta-blockers around the time of surgery for patients with symptoms of angina, known coronary artery disease or poorly controlled high blood pressure. Like any medicines, beta blockers can have side effects, and are not for everyone. Some hospitals have recently begun using special order forms for physicians to assure that appropriate patients are offered beta-blockers at the time of their surgery in a safe manner.

If you are planning to have surgery, and you have a history of heart disease, angina (chest pains from clogged arteries around the heart), high blood pressure or risk factors for coronary artery disease, ask your physician or surgeon if a beta-blocker is right for you.

When it comes to major surgery and heart disease, "a beta-blocker a day may just keep the heart attacks away."

Dr. Fish practices family medicine at the Martinez Health Center.