Aurelio Rojas, cardiologist: "This medication not only doesn't protect, but in some cases it can actually harm you."

For 40 years, it was assumed that beta-blockers were essential after a heart attack. They were considered a shield to prevent further attacks and protect the heart. However, scientific evidence has just taken an unexpected turn. A study recently published in the prestigious New England Journal of Medicine shows that these drugs not only offer no benefits in some patients, but can even be harmful.

Cardiologist Aurelio Rojas explained this in a recent video. "This medication not only doesn't protect, but in some cases it can actually harm you," he asserts. His words refer to an international study led in Spain by the National Center for Cardiovascular Research (CNIC), known as the REBOOT trial, which involved more than 8,500 patients from 109 hospitals.

The trial results are clear: in people who have survived a heart attack and maintain normal ventricular function—that is, with preserved heart strength—treatment with beta-blockers such as bisoprolol, nebivolol, or carvedilol does not improve patient outcomes. It does not reduce mortality or hospital readmissions. And most strikingly, in the case of women, it increases the risk of suffering another heart attack, developing heart failure, or even dying.

Rojas summarizes it in an instructive way: four decades ago, the situation was very different. Most patients who survived a heart attack were left with severely damaged hearts, and in that context, beta-blockers were shown to reduce mortality. But today, the situation has changed thanks to medical advances. The development of the "heart attack code," early reperfusion, and angioplasty have allowed approximately 70% of those affected to maintain their hearts in normal condition after the event.

The key is to differentiate between two scenarios. When the heart is weakened, there is heart failure, or arrhythmias occur, beta-blockers remain a safe and useful treatment. But if the patient has a preserved ejection fraction—that is, a heart that beats with normal force— the drugs offer no benefit and may be unnecessary or harmful.

The specialist himself explained: "If you've had a heart attack, review your reports and see if they show 'preserved or normal ejection fraction.' In that case, consult your cardiologist, because discontinuing them may be the best course of action," he added. However, Rojas insists that it's not about abandoning medication without supervision. The decision should always be individualized and guided by a doctor, as each heart responds differently.

The impact of the study is significant, as it calls into question a recommendation that has shaped clinical practice for decades. However, the cardiologist points out that this evolution is part of the natural process of science. "Science doesn't make mistakes when it corrects itself; rather, it evolves and improves," he asserts. Each trial adds nuances and allows treatments to be adapted to the current realities of patients, who are no longer the same as they were forty years ago.

The final message is clear: there is no single model for the heart after a heart attack, and medicine must adapt to each case. Far from being a failure, the new evidence opens the door to more personalized and effective care.

The REBOOT trial is an example of how medical advances force a rethinking of dogmas. Thanks to improved emergency treatments, most patients no longer fit the profile for which therapies were designed in the 1980s. This explains why a drug that saved lives back then may be unnecessary today for a large group of people.