Department of Vascular Medicine (F4-139), Academic Medical Centre, Amsterdam, The Netherlands.
Eur J Heart Fail. 2011 Feb;13(2):220-6. doi: 10.1093/eurjhf/hfq176. Epub 2010 Oct 14.
Heart failure (HF) is associated with a prothrombotic state, resulting in an increased risk for thrombo-embolic events. Studies suggest a reduced prothrombotic state when non-selective beta-blockers relative to selective beta-blockers are given. We studied the influence of non-selective beta-blockers compared with selective beta-blockers on the occurrence of arterial and venous thrombo-embolic events in patients with HF.
Data were obtained from the PHARMO Record Linkage System, a population-based registry of pharmacy records linked with hospital discharge records in The Netherlands. In the period of 1998-2007, 20 870 patients were hospitalized for HF. We used Cox regression analysis with time-varying beta-blocker covariate to assess the difference in the incidence of thrombo-embolic events [acute coronary syndrome (ACS), stroke, or pulmonary embolism] among patients. Median follow-up was 2.0 years (inter-quartile range: 0.7-4.1). Directly after discharge, 6558 patients were prescribed a selective beta-blocker and 2202 patients a non-selective beta-blocker. The hazard ratio (HR) for any thrombo-embolic event for non-selective beta-blockers compared with selective beta-blockers was 0.76 [95% confidence interval (CI): 0.64-0.89]. After adjustment, the difference remained (HR 0.84, 95% CI: 0.72-0.99). The effect was most prominent for ACS (HR 0.78, 95% CI: 0.65-0.93), and not clear for stroke (HR 1.00, 95% CI: 0.67-1.50) or pulmonary embolism (HR 1.33, 95% CI: 0.66-2.71).
In patients with HF, the use of non-selective beta-blockers was associated with a lower risk of thrombo-embolic events than selective beta-blockers. Whether this beneficial effect is caused by the additional beta2-receptor blockade remains to be elucidated. These findings need to be validated in a well-designed randomized study.
心力衰竭（HF）与血栓形成状态有关，导致血栓栓塞事件的风险增加。研究表明，与选择性β受体阻滞剂相比，非选择性β受体阻滞剂可降低血栓形成状态。我们研究了非选择性β受体阻滞剂与选择性β受体阻滞剂相比对 HF 患者动脉和静脉血栓栓塞事件发生的影响。
数据来自 PHARMO 记录链接系统，这是一个基于人群的药房记录数据库，与荷兰的医院出院记录相关联。在 1998 年至 2007 年期间，有 20870 名患者因 HF 住院。我们使用时变β受体阻滞剂协变量的 Cox 回归分析来评估患者中血栓栓塞事件（急性冠状动脉综合征（ACS）、中风或肺栓塞）发生率的差异。中位随访时间为 2.0 年（四分位距：0.7-4.1）。直接出院后，6558 名患者开了选择性β受体阻滞剂，2202 名患者开了非选择性β受体阻滞剂。与选择性β受体阻滞剂相比，非选择性β受体阻滞剂的任何血栓栓塞事件的危害比（HR）为 0.76（95%置信区间（CI）：0.64-0.89）。调整后，差异仍然存在（HR 0.84，95%CI：0.72-0.99）。这种效果在 ACS 中最为显著（HR 0.78，95%CI：0.65-0.93），而在中风（HR 1.00，95%CI：0.67-1.50）或肺栓塞（HR 1.33，95%CI：0.66-2.71）中不明显。
在 HF 患者中，与选择性β受体阻滞剂相比，使用非选择性β受体阻滞剂与血栓栓塞事件风险降低相关。这种有益效果是否是由β2 受体阻滞引起的仍有待阐明。这些发现需要在精心设计的随机研究中得到验证。
