Impact of cardioselective beta-blockers on mortality in patients with chronic obstructive pulmonary disease and atherosclerosis.
BACKGROUND
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) because they may worsen symptoms.


OBJECTIVE
We investigated the relationship between cardioselective beta-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.


RESULTS
There were 1,205 (39%) patients with COPD of whom 462 (37%) received cardioselective beta-blocking agents. beta-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 beta-blockers were associated with reduced mortality in patients with COPD undergoing vascular surgery. In carefully selected patients with COPD, the use of cardioselective beta-blockers appears to be safe and associated with reduced mortality.
Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Yvette R B M
YR
van Gestel
Sanne E
SE
Hoeks
Don D
DD
Sin
Gijs M J M
GM
Welten
Olaf
O
Schouten
Han J
HJ
Witteveen
Cihan
C
Simsek
Henk
H
Stam
Frans W
FW
Mertens
Jeroen J
JJ
Bax
Ron T
RT
van Domburg
Don
D
Poldermans
D000318:Adrenergic beta-Agonists / Q000627:therapeutic use*; D000319:Adrenergic beta-Antagonists / Q000009:adverse effects*; D000368:Aged; D004344:Drug Incompatibility; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000188:drug therapy*; D012189:Retrospective Studies; D016019:Survival Analysis
D000318:Adrenergic beta-Agonists; D000319:Adrenergic beta-Antagonists