title: Topical Beta-Blockers and Cardiovascular Mortality: Systematic Review and Meta-Analysis with Data from the EPIC-Norfolk Cohort Study.
abstract: To determine if topical beta-blocker use is associated with increased cardiovascular mortality, particularly among people with self-reported glaucoma.
  
  
  
  All participants who participated in the first health check (N = 25,639) of the European Prospective Investigation into Cancer (EPIC) Norfolk cohort (1993-2013) were included in this prospective cohort study, with a median follow-up of 17.0 years. We determined use of topical beta-blockers at baseline through a self-reported questionnaire and prescription check at the first clinical visit. Cardiovascular mortality was ascertained through data linkage with the Office for National Statistics mortality database. Hazard ratios (HRs) were estimated using multivariable Cox regression models. Meta-analysis of the present study's results together with other identified literature was performed using a random effects model.
  
  
  
  We did not find an association between the use of topical beta-blockers and cardiovascular mortality (HR 0.93, 95% confidence interval, CI, 0.67-1.30). In the 514 participants with self-reported glaucoma, no association was found between the use of topical beta-blockers and cardiovascular mortality (HR 0.89, 95% CI 0.56-1.40). In the primary meta-analysis of four publications, there was no evidence of an association between the use of topical beta-blockers and cardiovascular mortality (pooled HR estimate 1.10, 95% CI 0.84-1.36).
  
  
  
  Topical beta-blockers do not appear to be associated with excess cardiovascular mortality. This evidence does not indicate that a change in current practice is warranted, although clinicians should continue to assess individual patients and their cardiovascular risk prior to commencing topical beta-blockers.
authors.affiliation: a Department of Public Health and Primary Care , University of Cambridge , Cambridge , UK.
authors.forename: Claude
authors.initials: C
authors.lastname: Pinnock
authors.affiliation: a Department of Public Health and Primary Care , University of Cambridge , Cambridge , UK.|b NIHR Biomedical Research Centre for Ophthalmology , Moorfields Eye Hospital and UCL Institute of Ophthalmology , London , UK.
authors.forename: Jennifer L Y
authors.initials: JL
authors.lastname: Yip
authors.affiliation: a Department of Public Health and Primary Care , University of Cambridge , Cambridge , UK.|b NIHR Biomedical Research Centre for Ophthalmology , Moorfields Eye Hospital and UCL Institute of Ophthalmology , London , UK.
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Khawaja
authors.affiliation: a Department of Public Health and Primary Care , University of Cambridge , Cambridge , UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Luben
authors.affiliation: a Department of Public Health and Primary Care , University of Cambridge , Cambridge , UK.
authors.forename: Shabina
authors.initials: S
authors.lastname: Hayat
authors.affiliation: c Department of Ophthalmology , Norfolk and Norwich University Hospital , Norwich , UK.
authors.forename: David C
authors.initials: DC
authors.lastname: Broadway
authors.affiliation: b NIHR Biomedical Research Centre for Ophthalmology , Moorfields Eye Hospital and UCL Institute of Ophthalmology , London , UK.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Foster
authors.affiliation: a Department of Public Health and Primary Care , University of Cambridge , Cambridge , UK.
authors.forename: Kay-Tee
authors.initials: KT
authors.lastname: Khaw
authors.affiliation: d MRC Epidemiology Unit , University of Cambridge School of Clinical Medicine , Cambridge , UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Wareham
mesh_terms: D000287:Administration, Topical; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000401:mortality*; D005901:Glaucoma / Q000150:complications*; D006801:Humans; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: Beta-blockers; cardiovascular; epidemiology; mortality; topical