Medical Bulletin 03/September/2025 - Video

No Benefit of Beta Blockers in Certain Heart Attack Patients: REBOOT Trial Finds

In a new study published in The New England Journal of Medicine and European Heart Journal, researchers revealed that beta blockers—long considered a cornerstone of post-heart attack care—offer no clinical benefit for patients who have had an uncomplicated myocardial infarction with preserved heart function. The results of the REBOOT trial were presented during a “Hot Line” session at the European Society of Cardiology Congress in Madrid and are expected to prompt a major shift in clinical guidelines.

Beta blockers have been routinely prescribed for over four decades to reduce the risk of repeat cardiac events following a heart attack. However, with advances in cardiac care, their role in patients with no complications and preserved ejection fraction had remained untested in large-scale trials—until now.

The REBOOT trial, coordinated by Spain’s CNIC and the Mario Negri Institute in Milan, enrolled 8,505 patients across 109 hospitals in Spain and Italy. Participants—all of whom had preserved heart function following a heart attack—were randomly assigned to receive or not receive beta blockers after hospital discharge. All other aspects of care followed current clinical standards. Patients were followed for a median of 3.7 years.

The results showed no significant difference between the two groups in terms of mortality, recurrent heart attacks, or hospitalizations due to heart failure.

A key substudy, published in the European Heart Journal, revealed an important sex-specific finding: women treated with beta blockers had a 2.7% higher absolute risk of death, heart attack, or heart failure hospitalization than those who were not, while men showed no such increased risk.

“This trial will reshape all international clinical guidelines,” said Dr. Valentin Fuster, senior investigator and President of Mount Sinai Fuster Heart Hospital.

“REBOOT will change clinical practice worldwide,” added Principal Investigator Dr. Borja Ibáñez. “Currently, more than 80 percent of patients with uncomplicated myocardial infarction are discharged on beta blockers. The REBOOT findings represent one of the most significant advances in heart attack treatment in decades.”

This study not only questions the continued use of legacy treatments but also aims to simplify care, minimize side effects, and improve long-term outcomes for heart attack survivors.

Reference: Beta-Blockers after Myocardial Infarction without Reduced Ejection Fraction, New England Journal of Medicine (2025). www.nejm.org/doi/10.1056/NEJMoa2504735

Head Injuries May Raise Brain Cancer Risk: Major Studies Reveal

A new wave of research, published across multiple journals including Jama Network Open, has uncovered a troubling connection: moderate to severe traumatic brain injuries (TBIs) may significantly increase the risk of developing malignant brain tumors later in life.

While head injuries have long been linked to neurological issues like memory loss and dementia, recent studies now suggest that certain types of brain trauma could potentially trigger cancerous changes in brain tissue. Understanding this link is becoming increasingly important, especially as head injuries from contact sports, falls, and accidents remain common.

The main study tracked health records of more than 75,000 participants between 2000 and 2024. Researchers found that 0.6% of those with moderate to severe traumatic brain injuries developed malignant brain tumors within three to five years post-injury—a rate significantly higher than in individuals with no history of traumatic brain injuries. Mild injuries, however, showed no increased cancer risk. A separate 2024 study involving nearly two million U.S. veterans found that moderate/severe traumatic brain injuries nearly doubled the risk of brain cancer, while penetrating traumatic brain injuries more than tripled it.

Supporting data came from Afghanistan, where a case-control study found a 2.6-fold increased risk of brain tumors in people with past head trauma. In Brazil, researchers observed a 1.49-fold rise, which increased with repeated injuries. A global study further linked male meningioma cases to head injuries occurring 15 to 24 years earlier, showing a 5.4-fold increase in risk.

On a cellular level, scientists at University College London (UCL) found that head injuries in mice, when combined with the loss of the tumor-suppressor gene p53, caused brain support cells (astrocytes) to become stem-like and potentially cancerous.

Though the absolute risk remains low, the consistent patterns across studies suggest a real association. These findings emphasize the importance of long-term medical monitoring for those with serious head injuries and underline the urgent need for better safety measures and awareness worldwide.

Reference:https://www.massgeneralbrigham.org/en/about/newsroom/press-releases/link-between-tbi-history-malignant-brain-tumor-development#:~:text=Key%20takeaways%20*%20Mass%20General%20Brigham%20researchers,in%20adults%20with%20moderate%20to%20severe%20TBI.

Is Your Mental Health Putting Your Heart at Risk?

A new report from Emory University, published in The Lancet Regional Health – Europe, reveals that individuals with mental health conditions face a 50% to 100% higher risk of developing heart disease—and a 60% to 170% higher risk of poor outcomes if they already have cardiovascular disease (CVD). This metareview, led by Dr. Viola Vaccarino, MD, PhD, is part of a broader effort to highlight disparities in heart health across women, the elderly, racial minorities, and those with mental illness.

The Emory team analyzed data linking major mental health conditions—including depression, anxiety, bipolar disorder, PTSD, and schizophrenia—to increased cardiovascular risk. The report found the following associated increases: 72% for major depression, 57% for PTSD, 61% for bipolar disorder, 50% for panic disorder, 70% for phobic anxiety, and nearly 100% for schizophrenia.

The researchers also emphasized a two-way relationship. “More than 40 percent of those with cardiovascular disease also have a mental health condition,” says Dr. Vaccarino.

The report highlights biological links between mental health and heart disease, focusing on the role of the autonomic nervous system (ANS) and the hypothalamic-pituitary adrenal axis (HPA). These systems, when dysregulated, can lead to inflammation, metabolic issues, high blood pressure, and other risk factors for heart disease.

Social determinants also play a role. Barriers like affordability, limited access to care, and stigma often disrupt care for people with mental illness. Mental health conditions are rarely considered in cardiovascular risk prediction models and are frequently excluded from clinical trials.

“The tight connection between cardiovascular and psychological health warrants changes in the health care system that are more amenable to patients with comorbidities,” says Dr. Vaccarino.

Ultimately, the report calls for healthcare reform that recognizes the rights of people with mental illness to achieve equitable health outcomes through integrated, interdisciplinary care.

Reference: Mental health disorders and their impact on cardiovascular health disparities, Vaccarino, Viola et al. The Lancet Regional Health – Europe, Volume 56, 101373