Please use this identifier to cite or link to this item:
Title: Selectivity of beta-blockers, cardiovascular and all-cause mortality in people with hypoglycaemia: an observational study
Authors: Davies, M
Zaccardi, F
Nystrup Husemoen, L
Thorsted, BL
Webb, D
Khunti, K
Paul, SK
First Published: 15-Feb-2019
Publisher: Elsevier for 1. Italian Society for the Study of Atherosclerosis 2. Italian Society of Diabetology 3. Italian Society of Human Nutrition
Citation: Nutrition, Metabolism and Cardiovascular Diseases, 2019, in press
Abstract: Background and Aims The association of beta-blockers and their selectivity with mortality and cardiovascular events in patients with and without hypoglycaemia is unknown. Methods and Results Insulin-treated patients with diabetes were identified within the UK CPRD database. All-cause deaths, cardiovascular events, and hypoglycaemic episodes were captured to assess the interaction between beta-blocker therapy and selectivity with hypoglycaemia. 13682 patients, of which 2036 (14.9%) with at least one hypoglycaemic episode, were included; 3148 deaths and 1235 cardiovascular events were recorded during a median of 2.3 and 4.7 years in patients with and without incident hypoglycaemia, respectively. Treatment with any beta-blocker was not associated with risk of death in both patients with and without hypoglycaemia, without significant interaction. Compared to no therapy, non-selective beta-blockers were associated with higher risk of death in patients without hypoglycaemia (hazard ratio (HR) 2.93 [1.26–6.83] in the fully adjusted model) but not in those with hypoglycaemia; interactions was not significant. For beta1-selective beta-blockers, there was no association with mortality in both patients with and without hypoglycaemia, without significant interaction. After missing data imputation, results were consistent for non-selective beta-blockers (HR in patients without hypoglycaemia 1.59 [1.22–2.08]) while indicated a reduced risk of death for beta1-selective beta-blockers in patients with hypoglycaemia (HR 0.76 [0.61–0.94]). Due to few cardiovascular events, complete-case analysis compared only any vs no beta-blocker therapy and indicated no associations with therapy or interaction by hypoglycaemia. Conclusion In patients with hypoglycaemic episodes, treatment with beta1-selective beta-blockers may potentially reduce the risk of death. These explorative findings and the potential role of confounding by indication need to be evaluated in other studies.
DOI Link: 10.1016/j.numecd.2019.01.006
eISSN: 1590-3729
Embargo on file until: 15-Feb-2020
Version: Post-print
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © 2019 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. After an embargo period this version of the paper will be an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License (, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Description: The file associated with this record is under embargo until 12 months after publication, in accordance with the publisher's self-archiving policy. The full text may be available through the publisher links provided above.
Appears in Collections:Published Articles, College of Medicine, Biological Sciences and Psychology

Files in This Item:
File Description SizeFormat 
Manuscript_R2.pdfPost-review (final submitted author manuscript)240.55 kBAdobe PDFView/Open

Items in LRA are protected by copyright, with all rights reserved, unless otherwise indicated.