EFFECT OF BETA-BLOCKERS CLASS, CARDIOSELECTIVE VERSUS NON-CARDIOSELECTIVE, ON MORTALITY IN PATIENTS WITH COPD AND CARDIOVASCULAR DISEASE
Jebbawi LA, Jia KQ, and Ruzieh M. EFFECT OF BETA-BLOCKERS CLASS, CARDIOSELECTIVE VERSUS NON-CARDIOSELECTIVE, ON MORTALITY IN PATIENTS WITH COPD AND CARDIOVASCULAR DISEASE. Journal of the American College of Cardiology 2021; 77(18):1684.
Journal of the American College of Cardiology
Background: Chronic obstructive pulmonary disease (COPD) and cardiovascular disease often coexist, and the presence of heart disease increases mortality in patients with COPD and vice versa. Whenever indicated, cardioselective beta-blockers (βB) are often recommended over non-cardioselective βB in patients with COPD. We sought to clarify the evidence supporting this approach.
Methods: We searched Pubmed and MEDLINE for relevant studies. We calculated the risk ratio (RR) of mortality using the Mantel Haenszel random effect model. We performed a meta-regression analysis using the percentage of patients using cardioselective βB in each trial as a moderator variable.
Results: Data from 14 studies comprising 91,714 patients were included. There was no significant difference in overall mortality between patients who received cardioselective vs. non-cardioselective βB (RR: 1.01, 95% CI: 0.90 - 1.12), figure 1A. However, when using the percentage of patients taking cardioselective βB as a moderator variable, heterogeneity became moderate (Tau2: 0.01, P: 0.01, R2: 0.79), and there was a strong correlation between the percentage of cardioselective βB used in each trial and the reduction in mortality, such as when the percentage of patients using cardioselective βB in the study increases, the reduction in mortality is higher, figure 1B.
Conclusion: Cardioselective βB use may be associated with lower mortality in COPD patients. This hypothesis should be tested in a formal randomized controlled trial.