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Meta-Analysis
. 2014 Nov 26;9(11):e113048.
doi: 10.1371/journal.pone.0113048. eCollection 2014.

Beta-blockers reduced the risk of mortality and exacerbation in patients with COPD: a meta-analysis of observational studies

Qingxia Du  1 , Yongchang Sun  1 , Ning Ding  1 , Lijin Lu  1 , Ying Chen  1
Affiliations
Meta-Analysis

Beta-blockers reduced the risk of mortality and exacerbation in patients with COPD: a meta-analysis of observational studies

Qingxia Du et al. PLoS One. .

Abstract

Background: Cardiovascular disease is a primary cause of death in patients with chronic obstructive pulmonary disease (COPD). Beta-blockers have been proved to reduce morbidity and improve survival in patients with cardiac diseases. But the effects of beta-blockers on outcomes in patients with COPD remain controversial. The objective of this meta-analysis was to assess the effect of beta-blockers on mortality and exacerbation in patients with COPD.

Methods: An extensive search of the EMBASE, MEDLINE and Cochrane was performed to retrieve the studies of beta-blockers treatment in patients with COPD. The random effects model meta-analysis was used to evaluate effect on overall mortality and exacerbation of COPD.

Results: Fifteen original observational cohort studies with a follow-up time from 1 to 7.2 years were included. The results revealed that beta-blockers treatment significantly decreased the risk of overall mortality and exacerbation of COPD. The relative risk (RR) for overall mortality was 0.72 (0.63 to 0.83), and for exacerbation of COPD was 0.63 (0.57 to 0.71). In subgroup analysis of COPD patients with coronary heart disease or heart failure, the risk for overall mortality was 0.64 (0.54-0.76) and 0.74 (0.58-0.93), respectively.

Conclusion: The findings of this meta-analysis confirmed that beta-blocker use in patients with COPD may not only decrease the risk of overall mortality but also reduce the risk of exacerbation of COPD. Beta-blocker prescription for cardiovascular diseases needs to improve in COPD patients.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Study flow diagram in this meta-analysis.
Figure 2
Figure 2. Forest plot showing beta-blockers use and mortality risk in COPD patients.
Three subgroups were analysis according to the comorbid conditions of COPD. This Forest plot represents the relative risk (RR) (95% confidence interval) for mortality in COPD patients treated with beta-blockers compared with controls. (see also weight values on the right).
Figure 3
Figure 3. Forest plot of beta-blockers use and exacerbation of COPD risk in COPD patients.
Figure 4
Figure 4. Sensitivity analysis of the meta-analysis of the association between beta-blockers use and mortality risk in COPD patients.
The meta-analysis is dominated by the Gottlieb study and Ekstrom study.
Figure 5
Figure 5. Begg’s Funnel Plots with Pseudo 95% Confidence Limits for studies reporting beta-blockers use and mortality in COPD patients.
There is no evidence of bias in the test or the formal plot (t = 0.90, p = 0.382).
See this image and copyright information in PMC

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