- 期刊
- OpenAccess
Beta-blocker Therapy and Future Risk of Lower Limb Amputation in Patients with Diabetes and Peripheral Artery Disease
摘要
Background: Theoretically, beta-adrenoceptor blocking agents (beta-blockers) may reduce peripheral perfusion via α-receptor-mediated peripheral vasoconstriction. The use of beta-blockers in patients with peripheral artery disease (PAD) is therefore controversial. According to the European Society of Cardiology guideline for PAD in 2019, beta-blockers are not contraindicated. However, there is little evidence regarding the limb outcomes of beta-blocker use in diabetes mellitus (DM) patients with PAD. Methods: Patients with type 2 DM and PAD were identified and retrospectively enrolled from Taiwan's National Health Insurance Research Database. To analyze the impact of beta-blocker use on limb outcomes, patients using BB were compared with propensity score-matched BB non-users in a 1:1 ratio. A total of 40,250 propensity score-matched pairs of beta-blocker users (20,125 patients) and non-users (20,125 patients) with type 2 DM and established diagnosis of PAD were examined over the period 2000 to 2011. Results: A total of 86,859 patients were enrolled. The mean age of beta-blocker users was 64.4 ± 11.7 years, and of non-users 64.5 ± 11.6 years. During the mean follow-up of 15 months, a total of 365 beta-blocker users and 434 non-users underwent amputations. Compared with non-users, beta-blocker users were associated with a lower risk of amputation due to PAD (hazard ratio (HR): 0.83; 95% confidence interval (CI): 0.72-0.96). Additionally, beta-blocker users had a lower risk of all-cause mortality than non-users (HR: 0.94; 95% CI: 0.91-0.98). By comparison, the risks of in-hospital cardiovascular death, myocardial infarction and ischemic stroke did not differ significantly between users and non-users. Conclusions: This nationwide population-based diabetes cohort study demonstrated that treatment with beta-blockers is associated with lower risk of all-cause mortality and amputation in type 2 DM patients with PAD.