Published ahead of print on June 19, 2008, doi:10.1164/rccm.200803-384OC
Am. J. Respir. Crit. Care Med., Volume 178, Number 7, October 2008, 695-700
A more recent version of this article appeared on October 1, 2008
Submitted on March 7, 2008
Accepted on June 19, 2008
The Impact of Cardioselective Beta-Blockers on Mortality in Patients with COPD and Atherosclerosis
Yvette RBM van Gestel1, Sanne E Hoeks1, Don D Sin2, Gijs MJM Welten3, Olaf Schouten3, Han J Witteveen4, Cihan Simsek4, Henk Stam5, Frans W Mertens5, Jeroen J Bax6, Ron T van Domburg4, and Don Poldermans1*
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, Erasmus Medical Center, Rotterdam, The Netherlands,
4 Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands,
5 Department of Pulmonology, Erasmus Medical Center, Rotterdam, The Netherlands,
6 Department of Cardiology, Leiden Medical Center, Leiden, The Netherlands
* To whom correspondence should be addressed. E-mail: d.poldermans{at}erasmusmc.nl.
Rational: Beta-blocker use is associated with improved health outcomes in patients with cardiovascular disease. There is a general reluctance to prescribe beta-blockers in patients with chronic obstructive pulmonary disease (COPD) as they may worsen symptoms.
Objective: We investigated the relationship between cardioselective beta-blockers and mortality in COPD patients undergoing major vascular surgery.
Measurements and Main Results: We evaluated 3371 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 based on symptoms and spirometry. The major endpoints were 30-day and long-term mortality following vascular surgery. Patients were defined as receiving low-dose therapy if the dosage was <25% of the maximum recommended therapeutic dose; dosages higher than this were defined as intensified dose. There were 1310 (39%) patients with COPD of whom 462 (35%) received cardioselective beta-blocking agents. Beta-blocker use was associated independently with lower 30-day (odds ratio, OR, 0.37; 95% confidence interval, CI, 0.19-0.72) and long-term mortality in patients with COPD (hazards ratio, HR, 0.73; 95%CI 0.60-0.88). Intensified dose was associated with both reduced 30-day and long-term mortality in COPD patients, while low dose was not.
Conclusions: Cardioselective beta-blockers were associated with reduced mortality in COPD patients undergoing vascular surgery. In carefully selected patients with COPD, the use of cardioselective beta-blockers appears to be safe and associated with reduced mortality.
Key words: Chronic obstructive pulmonary disease, beta-adrenergic blocking agents, peripheral arterial disease, vascular surgery
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