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₂-Adrenergic Receptor Genotype and Survival After Acute Coronary Syndrome

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To the Editor: The study by Dr Lanfear and colleagues¹ showed an apparent disconnect between the effects that ADRB2 and ADRB1 variants have on survival in patients receiving -blockers after an acute coronary syndrome. The homozygous composite genotypes comprising Arg-Arg16 /Gln-Gln 27 (46AA/79CC) and Gly-Gly16/Glu-Glu 27 (46GG/79GG) were associated with a higher and lower risk of death, respectively, amounting to a 14% difference in mortality rate over 3 years.

The acute fall in serum potassium level and diastolic blood pressure in response to ADRB2 stimulation by albuterol is significantly greater in patients with genotype 46AA/79CC compared with 46GG/79GG.² This suggests the possibility of a genetic susceptibility to the ADRB2-mediated adverse effects of raised levels of endogenous circulating epinephrine in the high-risk group when treated with -blockers.

The authors did not state which -blockers were used in the study. This is relevant because the more commonly used 1-selective blockers might . . . [Full Text of this Article]

Catherine M. Jackson, MD
Tayside Centre for General Practice

Brian J. Lipworth, MD
b.j.lipworth@dundee.ac.uk
Division of Medicine and Clinical Pharmacology
Ninewells Hospital and Medical School
Dundee, Scotland

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