β-Blockers in myocardial infarction and coronary artery disease with a preserved ejection fraction: recommendations, mechanisms, and concerns.

β-Blockers are a recommended therapy in patients with acute myocardial infarction and coronary artery disease. β-Blockers markedly and unequivocally reduce mortality in patients with myocardial infarction and coronary artery disease with heart failure and a reduced ejection fraction. However, the mortality effects of β-blockers in patients with a preserved ejection fraction are not established even though they represent the majority of patients with coronary artery disease. In this review, we will assess the evidence basis of the recommendations for β-blockers in the US guidelines and discuss emerging concerns about the use of β-blockers and other heart rate-lowering medications in patients with a preserved ejection fraction that suggest that their long-term adverse outcomes may outweigh their antianginal benefits.