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Use of cardioselective β-blockers and overall death and cardiovascular outcomes in patients with COPD: a population-based cohort study

  • Pharmacoepidemiology and Prescription
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Abstract

Purpose

Use of β-blockers (BBs) in patients with chronic obstructive pulmonary disease (COPD) and cardiovascular diseases is supported by increasing evidence. However, most of these studies focused on the survival outcome and used a non-active comparison, prevalent-user design. We aimed to examine the risk of overall death and cardiovascular outcomes associated with use of cardioselective BBs using an active comparison, incident cohort approach.

Methods

We identified COPD patients initiating cardioselective BBs or non-dihydropyridine calcium channel blockers (CCBs) between 2007 and 2011 in the population-based Taiwan database. A Cox regression model was applied to estimate hazard ratios (HRs) for overall death, cardiovascular death, and cardiovascular events comparing cardioselective BBs and non-dihydropyridine CCBs after propensity score matching. We also conducted sensitivity analyses to quantify the unmeasured confounding effect from COPD severity.

Results

A total of 107,902 patients were included. Cardioselective BBs were associated with a modest, lower risk of overall death (HR, 0.85; 95 % CI, 0.81–0.88). The reduced risk of overall death, however, was vulnerable to distribution of COPD severity and was easily weakened with lower prevalence of severe COPD patients in the initiators of cardioselective BBs and higher prevalence of severe COPD patients in the initiators of non-dihydropyridine CCBs. No excess benefit for cardiovascular death (HR, 1.05; 95 % CI, 0.97–1.13) or cardiovascular events (HR, 0.98; 95 % CI, 0.94–1.03) was detected.

Conclusion

The present study demonstrated a potential effect of confounding by COPD severity and therefore did not suggest an association between use of cardioselective BB and survival benefit in COPD patients.

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Authors and Affiliations

  1. Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, 02120, USA

    Yaa-Hui Dong

  2. Department of Internal Medicine, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei, 10002, Taiwan

    Chia-Hsuin Chang & Li-Chiu Wu

  3. Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, 10055, Taiwan

    Chia-Hsuin Chang & Mei-Shu Lai

Authors
  1. Yaa-Hui Dong
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  4. Mei-Shu Lai
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Corresponding author

Correspondence to Chia-Hsuin Chang.

Ethics declarations

The protocol was approved by the National Taiwan University Hospital Research Ethics Committee.

Funding

This study was in part supported by the Taiwan Department of Health grant (DOH101-TD-B-111-01), which did not play any role in the conception and design of study; collection, management, analysis, and interpretation of data; and preparation, review, or approval of the manuscript.

Conflict of interest

The authors declare that they have no competing interests.

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Dong, YH., Chang, CH., Wu, LC. et al. Use of cardioselective β-blockers and overall death and cardiovascular outcomes in patients with COPD: a population-based cohort study. Eur J Clin Pharmacol 72, 1265–1273 (2016). https://doi.org/10.1007/s00228-016-2097-y

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  • DOI: https://doi.org/10.1007/s00228-016-2097-y

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