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Impact of Cardioselective β-Blockers on Mortality in Patients with Chronic Obstructive Pulmonary Disease and Atherosclerosis

¹ Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands; ² Department of Medicine, University of British Columbia and the James Hogg iCAPTURE Center, St. Paul's Hospital, Vancouver, Canada; ³ Department of Vascular Surgery, ⁴ Department of Cardiology, and ⁵ Department of Pulmonology, Erasmus Medical Center, Rotterdam, The Netherlands; and ⁶ Department of Cardiology, Leiden Medical Center, Leiden, The Netherlands

Correspondence and requests for reprints should be addressed to Don Poldermans, M.D., Ph.D., Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands. E-mail: d.poldermans{at}erasmusmc.nl

Rationale: β-Blocker use is associated with improved health outcomes in patients with cardiovascular disease. There is a general reluctance to prescribe β-blockers in patients with chronic obstructive pulmonary disease (COPD) because they may worsen symptoms.

Objectives: We investigated the relationship between cardioselective β-blockers and mortality in patients with COPD undergoing major vascular surgery.

Methods: We evaluated 3,371 consecutive patients who underwent major vascular surgery at one academic institution between 1990 and 2006. The patients were divided into those with and without COPD on the basis of symptoms and spirometry. The major endpoints were 30-day and long-term mortality after vascular surgery. Patients were defined as receiving low-dose therapy if the dosage was less than 25% of the maximum recommended therapeutic dose; dosages higher than this were defined as intensified dose.

Measurements and Main Results: There were 1,205 (39%) patients with COPD of whom 462 (37%) received cardioselective β-blocking agents. β-Blocker use was associated independently with lower 30-day (odds ratio, 0.37; 95% confidence interval, 0.19–0.72) and long-term mortality in patients with COPD (hazards ratio, 0.73; 95% confidence interval, 0.60–0.88). Intensified dose was associated with both reduced 30-day and long-term mortality in patients with COPD, whereas low dose was not.

Conclusions: Cardioselective β-blockers were associated with reduced mortality in patients with COPD undergoing vascular surgery. In carefully selected patients with COPD, the use of cardioselective β-blockers appears to be safe and associated with reduced mortality.

Key Words: chronic obstructive pulmonary disease • β-adrenergic blocking agents • peripheral arterial disease • vascular surgery

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject β-Blockers are often withheld from patients with chronic obstructive pulmonary disease (COPD) because of fear of pulmonary worsening. However, cardioselective β-blockers are demonstrated to be safe and beneficial in patients with COPD. What This Study Adds to the Field Cardioselective β-blockers are beneficial in the reduction of mortality in patients with COPD undergoing vascular surgery, with an intensified dosage being most effective.

 

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