• Growing evidence supporting an antiatherosclerotic effect of b-blockade provided the stimulus for two clinical trials of the effect of b-blocker therapy on atherosclerosis progression. The first of these studies was the b-blocker Cholesterol-lowering Asymptomatic Plaque Study (BCAPS).

• Briefly, the aim of BCAPS was to investigate the antiatherogenic effect of low-dose (25 mg once daily) extended-release (ER) metoprolol succinate and a statin on the progression of carotid atherosclerosis.¹

• The study participants included 793 clinically healthy men and women (ages 49-70) who had right carotid artery plaque but no symptoms of coronary artery disease. Most patients had normal cholesterol levels.

• The study medications were ER metoprolol succinate 25 mg once daily and fluvastatin 40 mg once daily. Patients were randomly assigned to one of four drug combinations:

  - ER metoprolol succinate/placebo

  - Fluvastatin/placebo

  - ER metoprolol succinate/fluvastatin

  - Placebo/placebo

• The primary outcome measures of BCAPS were change in mean intima-media thickness (IMT) in the common carotid artery (10-mm section) and change in maximum IMT in the carotid bulb.

¹Hedblad B, Wikstrand J, Janzon L, Wedel H, Berglund G. Low-dose metoprolol CR/XL and fluvastatin slow progression of carotid intima-media thickness: Main results from the b-Blocker Cholesterol-Lowering Asymptomatic Plaque Study (BCAPS). Circulation. 2001;103:1721-1726.