Association between topical beta-blockers and risks of cardiovascular and respiratory disease in patients with glaucoma: a retrospective cohort study

Abstract

ObjectiveTo determine if topical beta-blocker use is associated with increased risks of cardiovascular and respiratory diseases in patients with glaucoma.SettingA retrospective cohort analysis was conducted using the database from Taiwan’s National Health Insurance programme.ParticipantsIn total, 12 336 newly diagnosed patients with glaucoma from January 2000 to December 2010 were included. The patients with glaucoma were subdivided into two cohorts according to whether they used topical beta-blockers or combination drugs (BBCDs).Primary outcome measuresThe study endpoints included pneumonia, acute respiratory failure, stroke and coronary artery disease (CAD). Univariable and multivariable Cox proportional hazards regression models were used to estimate HRs and 95% CIs for the endpoints of both cohorts.ResultsThe BBCD cohort had a slightly higher risk of acute respiratory failure (adjusted HRs=1.16, 95% CI 1.00 to 1.34) and lower risk of CAD (aHR=0.93, 95% CI 0.87 to 0.99) than the non-BBCD cohort. Additionally, the risk of stroke was significantly higher in BBCD cohort than in the non-BBCD cohort (aHR=1.39, 95% CI 1.23 to 1.58), especially the ischaemic stroke (aHR=1.44, 95% CI 1.26 to 1.64; aHR=1.44, 98.75% CI 1.21 to 1.71). After considering the multiplicative interaction of age and sex, the BBCD cohort do not have higher risk of all outcomes than the non-BBCD cohort. Further time-dependent regression analysis revealed BBCD cohort had higher risk of acute respiratory failure (aHR=1.17, 95% CI 1.01 to 1.35) and ischaemic stroke (aHR=1.44, 95% CI 1.26 to 1.65) than non-BBCD cohort. However, after considering the multiplicative interaction of age and sex, the BBCD cohort had no significantly higher risk of all outcomes than the non-BBCD cohort.ConclusionTopical beta-blocker is not associated with increased risks of cardiovascular and respiratory diseases in patients with glaucoma.

Prevalence and Risk Factors of Glaucoma Among Chinese People From the China Health and Retirement Longitudinal Study

“…Fibrates for dyslipidemia and inhaled corticosteroids for asthma were also reported to increase the risk of glaucoma and elevate IOP 32,33. On the contrary, recently, both a retrospective cohort study in Taiwan and a meta-analysis suggested that these side effects were overly exaggerated 34,35…”

“…32,33 On the contrary, recently, both a retrospective cohort study in Taiwan and a meta-analysis suggested that these side effects were overly exaggerated. 34,35 Nevertheless, the strong association between systemic diseases and glaucoma indicates that patients with glaucoma should be referred for regular general examinations and that internal physicians should refer patients for regular ophthalmological examinations, which will assist in clinical decision-making. Regarding the association between glaucoma and lifestyle habits, several studies have found that smokers and drinkers have a higher IOP and glaucoma prevalence than the reference group.…”