Beta-blockers reduce COPD flares and improve survival in COPD with CVD: ESC study

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death and is estimated to rise to be the third most common cause of death worldwide by 2020. Many patients with COPD have concomitant conditions, mostly coronary artery disease (CAD), that require the use of beta-blockers (BBs). The prevalence of COPD in patients with heart failure ranges from 20% to 32% of cases, and the prevalence of heart failure in COPD patients is >20%. Data from the REPOSI registry indicate a prevalence of heart failure close to 30% in COPD patients aged >65 years with comorbidities.

However, despite the clear evidence of BBs effectiveness, there is a general reluctance to use them in patients with COPD due to a perceived contraindication and fear of inducing adverse reactions and bronchospasm.

Yang YL et al. conducted a systematic review and meta-analysis of 49 studies (12 RCTs, 37 cohort or case-control studies), comprising 670,594 patients. They evaluated the effects of beta-blockers in patients with COPD and CVD. The major outcomes assessed were COPD exacerbation, all-cause mortality, and in-hospital mortality.

Key Findings of the study were:

♦In a subset of 17 studies, the researchers found cardioselective beta-blockers were associated with a lower risk of COPD exacerbation (hazard ratio [HR], 0.77), while non-cardioselective beta-blockers had no significant impact on COPD exacerbation.

♦Upon analysis of 22 studies they found, both cardioselective and non-cardioselective beta-blockers were associated with reduced risk (HR, 0.70) of all-cause mortality.

♦On subgroup analysis they found, the patients with heart failure and myocardial infarction demonstrated similarly favourable effects of beta-blockers on all-cause mortality.

♦They also found an association between beta-blockers and reduced risk of in-hospital mortality in five studies (HR, 0.67).

♦In five retrospective cohort studies, they observed that the patients on beta-blockers have lower average heart rates (mean difference -7.87) and reported no significant impact of beta-blockers on pulmonary function tests.

The authors concluded, "Beta-blocker use is associated with reduced in-hospital and all-cause mortality among patients with COPD and CVD. Use of cardioselective beta-blockers is associated with reduced risk of COPD exacerbation. Protective effects of beta-blockers may be driven in part by heart rate reduction".

The authors further added, "This meta-analysis provides reassurance that patients with COPD who have a cardiovascular indication for beta-blockade should be treated according to current guidelines. The apparent differential effect of cardioselective and non-cardioselective beta-blockers on COPD exacerbation is deserving of further study, but particularly in patients with COPD who have hyper-reactive airways, it may be prudent to choose cardioselective beta-blockers".

For further information:

European Heart Journal, ehaa793, https://doi.org/10.1093/eurheartj/ehaa793