Topical Beta-Blockers and Cardiovascular Mortality: Systematic Review and Meta-Analysis with Data from the EPIC-Norfolk Cohort Study

Claude Pinnock, Jennifer L.Y. Yip*, Anthony P. Khawaja, Robert Luben, Shabina Hayat, David C. Broadway, Paul J. Foster, Kay Tee Khaw, Nick Wareham

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

Purpose: To determine if topical beta-blocker use is associated with increased cardiovascular mortality, particularly among people with self-reported glaucoma. Methods: 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. Results: 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). Conclusion: 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.

Original languageEnglish
Pages (from-to)277-284
Number of pages8
JournalOphthalmic Epidemiology
Volume23
Issue number5
DOIs
Publication statusPublished - 2 Sep 2016
Externally publishedYes

Bibliographical note

Funding Information:
EPIC-Norfolk infrastructure and core functions are supported by grants from the Medical Research Council (G1000143) and Cancer Research UK (C864/A14136). The clinic for the third health examination was funded by Age UK Research into Ageing (262). Mr. Khawaja is a Wellcome Trust Clinical Research Fellow. Mr. Foster has received additional support from the Richard Desmond Charitable Trust (via Fight for Sight) and the Department for Health through the award made by the National Institute for Health Research to Moorfields Eye Hospital and the UCL Institute of Ophthalmology for a specialist Biomedical Research Centre for Ophthalmology. None of the funding organizations had a role in the design or conduct of the research.

Publisher Copyright:
© 2016, Published with License by Taylor & Francis © 2016 Claude Pinnock, Jennifer L. Y. Yip, Anthony P. Khawaja, Robert Luben, Shabina Hayat, David C. Broadway, Paul J. Foster, Kay-Tee Khaw, and Nick Wareham.

Keywords

  • Beta-blockers
  • cardiovascular
  • epidemiology
  • mortality
  • topical

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