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₂-Adrenergic Receptor Genotype and Survival After Acute Coronary Syndrome—Reply

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In Reply: The selection of optimal therapy for patients with acute coronary syndrome remains a major issue for this common medical problem. The authors of these 2 letters highlight that the mechanism of the effect of these variants' interaction with -adrenergic antagonists remains an unresolved and interesting question. Many plausible hypotheses can be proposed to explain the observations. In regard to the comments of Drs Snyder and Johnson, our data do not demonstrate that -adrenergic antagonists "increase mortality" in any subgroup. The results may reflect a lack of benefit of -blockade, rather than an actual harm due to therapy. The mechanism of effect they propose is intriguing and deserves further study.

That the mechanism is not completely understood is underscored by transgenic mouse data suggesting that the ₂ receptor may have favorable effects on cardiac function in mouse heart failure models.^1-2 This is counter to conventional wisdom that assumes that all . . . [Full Text of this Article]

David E. Lanfear, MD
Henry Ford Hospital
Heart and Vascular Institute
Detroit, Mich

John A. Spertus, MD, MPH
Mid America Heart Institute
St Luke's Hospital
Kansas City, Mo

Howard L. McLeod, PharmD
hmcleod@im.wustl.edu
Department of Medicine
Washington University School of Medicine
St Louis, Mo

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