Hey there, welcome to Paging Dr. Gupta. Thank you so much for joining us. As you know by now, this is the place where I get to hear from you. You've been sending in so many questions, great questions, sending in your stories. We're listening to them. I want you to know that. We're hopefully getting you information to help you better understand your health. Jennifer's back with us. What do we have first?

Hi, Sanjay. Today's question comes from Paul in New Westminster, British Columbia. He writes, I had a heart attack in 2007 and have since been on beta blockers. Should I continue them?

All right, Paul, thank you so much for your question. Beta blockers have been in the news a lot lately. And you know, for more than 40 years, they've been one of the most commonly prescribed medications in America. They've been prescribed as a standard treatment for people after a heart attack, sort of a first line therapy. The goal is to slow down the heart rate and hopefully prevent future heart attacks. That's why they've prescribed. But Doctors, scientists taking a closer look now at these medications, how much they're actually necessary and in whom. So today, beta blockers, what we know and what to consider if you're interested in stopping them like Paul is. We'll get into it right after the break. Stick with us.

'Okay, so Paul wants to know if he should consider going off his beta blocker. First of all, let me just say this to start. You should absolutely talk to your doctor about this. Absolutely. And let me put an exclamation mark on this. There is actually a black box warning about stopping beta blockers too abruptly. If you stop them, your heart rate can shoot up, your blood pressure can shoot up, and that can be a problem, obviously, if you've had a heart problem in the past in particular. So definitely talk to your doctor about this. If you do come off of beta blockers, you are likely to be titrated off, meaning going to lower dose and then a progressively lower dose before eventually stopping the medication altogether. So I'll just say it one more time, don't just stop your beta blockers, talk to you doctor about it. Now, as I've already mentioned, these are some of the most commonly prescribed medications in the United States. About 10% of all U.S. Adults take this type of medication and oftentimes they're on this medication for life. They're used to treat a wide range of problems including cardiac conditions like high blood pressure, certain arrhythmias, and even for things that you wouldn't expect like preventing migraines. Again, beta blockers slow down your heart rate and the way they do that is by blocking the action of epinephrine on the organs in your body. Those are neurotransmitters, responsible, sort of, for your fight or flight response. Now, some of the first trials looking at beta blockers as a prevention for a secondary heart event or a heart attack came about in the 1960s. So some of this data is 60 years old now. And much of the idea of using beta blockers as a post-heart attack treatment came about at a time before other treatments had been well developed. Like angioplasty for example, where you can quickly open up a blood vessel and restore blood flow to the heart. Blood thinners, statin medications, there have been a lot of developments in the world of cardiology since those initial trials on beta blockers were initially done. So, when researchers began re-evaluating the benefits of beta blockers, they began to find that in many cases, maybe around half the cases, there wasn't a significant difference between those who stayed on beta blockers and those who came off of them. And what got so much attention last week was a study published in the New England Journal of Medicine, which found essentially no difference in new heart attacks or mortality in people who had continued using beta blocker versus those who stopped. But I want to be specific here. The people who seemed to do the best coming off beta blockers was people who had stable heart function, normal heart function at about a year out. So in the immediate aftermath of having a heart attack, they were taking beta blockers for a period of time, but then after they stopped, with normal heart function, there seemed to be no difference between those who stopped and those who continued. I should point out that people who stopped taking the beta blockers, heart rate did go up. Blood pressure did go up. But it wasn't significant enough to cause a problem. And that's sort of the key. Now, again, you're saying, does this apply to all patients? As I mentioned, about half the patients are probably going to benefit from this new news. Stable patients, people whose heart function is good. And what I mean by that is that they have something known as an ejection fraction. How much blood does the heart eject with each pumping? If it's into the 50 or 60 or 70% range, that's considered pretty normal. So if you have stable heart function, meaning it's not changing, good heart function meaning a high enough ejection fraction, those are the people who are most likely going to be able to come off beta blockers. Talk to your doctor about this. If you do stop the beta blockers again, you're probably going to need to titrate off the beta blockers. The bottom line is this, health is personal. It's going to depend on your individual situation and there are lots of things to consider about this very important decision, including how good your heart function is. So make sure you discuss that with your doctor in particular before stopping any medications. Okay, time for a quick break, but when we return, the long-term side effects of beta blockers and what you should know about that.

And we are back with paging Dr. Gupta. Jennifer, what do we have next?

'Okay, here's a question from Larry. What are the long-term side effects of beta blockers?

'Alright. Long-term, short-term side effects, something we should always be discussing. I want to talk about that, but also just again, reinforce this point that we have gotten much better about taking care of those who have had heart attacks. To give you some context, in 1970, if someone who was 65 years old had a heart attack, they had about a 60% chance of actually leaving the hospital alive. Today, it's around 90%. And again, it's because of these wonderful new strategies in the world of cardiology. Because we can restore blood flow to the heart much more quickly, that means you can preserve heart muscle, and that means the heart's not under as much stress, and you don't need beta blockers as frequently. When it comes to side effects, because beta blockers lower heart rate and lower blood pressure, you're getting diminished blood flow to many parts of the body as well, including the hands and feet. And you get cold hands and feet. And it can be pretty significant, to the point where people don't want to do certain activities because of that. You may feel tired. You may have weight gain. People often feel lightheaded. Less common side effects can include depression, trouble sleeping, sexual dysfunction. And again, with these medications, oftentimes people have been taking them for a lifetime. So these side effects become part of their life. When it comes to cost, the medications typically about $20 or so for a month's supply. But again, that's every month for the rest of someone's life, those costs can add up. If you look at the modeling with this new news about beta blockers, it might mean about half the people who are currently on them to try and prevent another heart attack could stop taking the medication. That could benefit a lot of people in terms of side effects, and that could benefits society as well in terms cost. So definitely talk to your doctor about this.

'Thanks again for your question. And that's all the time we have for today. I just wanted to say that the ever-changing guidance about our health can often feel daunting. That's part of the reason we want to talk through these kinds of questions, which is exactly why you make this show. We listen to you. So if you've got a health question, send it in. We might just feature it on our next episode. Record a voice memo, email it to pagingdrgupta@cnn.com. That's pagingdrgupta@cnn.com or give us a call 470-396-0832 and leave a message. Thanks so much for listening.