Beta-blocker use and fall risk in older individuals: Original results from two studies with meta-analysis

Annelies C. Ham, S.C. van Dijk, Karin M.A. Swart, Anke W. Enneman, Nikita L. van der Zwaluw, Elske M. Brouwer-Brolsma, Natasja M. van Schoor, M.C. Zillikens, Paul Lips, Lisette C.P.G.M. de Groot, Albert Hofman, Renger F. Witkamp, André G. Uitterlinden, Bruno H. Stricker, Nathalie van der Velde

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Abstract

Aims: To investigate the association between use of β-blockers and β-blocker characteristics - selectivity, lipid solubility, intrinsic sympathetic activity (ISA) and CYP2D6 enzyme metabolism - and fall risk. Methods: Data from two prospective studies were used, including community-dwelling individuals, n = 7662 (the Rotterdam Study) and 2407 (B-PROOF), all aged ≥55 years. Fall incidents were recorded prospectively. Time-varying β-blocker use was determined using pharmacy dispensing records. Cox proportional hazard models adjusted for age and sex were applied to determine the association between β-blocker use, their characteristics - selectivity, lipid solubility, ISA and CYP2D6 enzyme metabolism - and fall risk. The results of the studies were combined using meta-analyses. Results: In total 2917 participants encountered a fall during a total follow-up time of 89529 years. Meta-analysis indicated no association between use of any β-blocker, compared to nonuse, and fall risk, hazard ratio (HR) = 0.97 [95% confidence interval (CI) 0.88-1.06]. Use of a selective β-blocker was also not associated with fall risk, HR = 0.92 (95%CI 0.83-1.01). Use of a nonselective β-blocker was associated with an increased fall risk, HR = 1.22 (95%CI 1.01-1.48). Other β-blocker characteristics including lipid solubility and CYP2D6 enzyme metabolism were not associated with fall risk. Conclusion: Our study suggests that use of a nonselective β-blocker, contrary to selective β-blockers, is associated with an increased fall risk in an older population. In clinical practice, β-blockers have been shown effective for a variety of cardiovascular indications. However, fall risk should be considered when prescribing a β-blocker in this age group, and the pros and cons for β-blocker classes should be taken into consideration.

Original languageEnglish
Pages (from-to)2292-2302
JournalBritish Journal of Clinical Pharmacology
Volume83
Issue number10
DOIs
Publication statusPublished - 2017

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Meta-Analysis
Cytochrome P-450 CYP2D6
Solubility
Odds Ratio
Confidence Intervals
Lipids
Enzymes
Independent Living
Proportional Hazards Models
Age Groups
Prospective Studies
Population

Keywords

  • CYP2D6
  • Falls
  • Meta-analysis
  • β-blockers

Cite this

Ham, A. C., van Dijk, S. C., Swart, K. M. A., Enneman, A. W., van der Zwaluw, N. L., Brouwer-Brolsma, E. M., ... van der Velde, N. (2017). Beta-blocker use and fall risk in older individuals: Original results from two studies with meta-analysis. British Journal of Clinical Pharmacology, 83(10), 2292-2302. https://doi.org/10.1111/bcp.13328
Ham, Annelies C. ; van Dijk, S.C. ; Swart, Karin M.A. ; Enneman, Anke W. ; van der Zwaluw, Nikita L. ; Brouwer-Brolsma, Elske M. ; van Schoor, Natasja M. ; Zillikens, M.C. ; Lips, Paul ; de Groot, Lisette C.P.G.M. ; Hofman, Albert ; Witkamp, Renger F. ; Uitterlinden, André G. ; Stricker, Bruno H. ; van der Velde, Nathalie. / Beta-blocker use and fall risk in older individuals : Original results from two studies with meta-analysis. In: British Journal of Clinical Pharmacology. 2017 ; Vol. 83, No. 10. pp. 2292-2302.
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title = "Beta-blocker use and fall risk in older individuals: Original results from two studies with meta-analysis",
abstract = "Aims: To investigate the association between use of β-blockers and β-blocker characteristics - selectivity, lipid solubility, intrinsic sympathetic activity (ISA) and CYP2D6 enzyme metabolism - and fall risk. Methods: Data from two prospective studies were used, including community-dwelling individuals, n = 7662 (the Rotterdam Study) and 2407 (B-PROOF), all aged ≥55 years. Fall incidents were recorded prospectively. Time-varying β-blocker use was determined using pharmacy dispensing records. Cox proportional hazard models adjusted for age and sex were applied to determine the association between β-blocker use, their characteristics - selectivity, lipid solubility, ISA and CYP2D6 enzyme metabolism - and fall risk. The results of the studies were combined using meta-analyses. Results: In total 2917 participants encountered a fall during a total follow-up time of 89529 years. Meta-analysis indicated no association between use of any β-blocker, compared to nonuse, and fall risk, hazard ratio (HR) = 0.97 [95{\%} confidence interval (CI) 0.88-1.06]. Use of a selective β-blocker was also not associated with fall risk, HR = 0.92 (95{\%}CI 0.83-1.01). Use of a nonselective β-blocker was associated with an increased fall risk, HR = 1.22 (95{\%}CI 1.01-1.48). Other β-blocker characteristics including lipid solubility and CYP2D6 enzyme metabolism were not associated with fall risk. Conclusion: Our study suggests that use of a nonselective β-blocker, contrary to selective β-blockers, is associated with an increased fall risk in an older population. In clinical practice, β-blockers have been shown effective for a variety of cardiovascular indications. However, fall risk should be considered when prescribing a β-blocker in this age group, and the pros and cons for β-blocker classes should be taken into consideration.",
keywords = "CYP2D6, Falls, Meta-analysis, β-blockers",
author = "Ham, {Annelies C.} and {van Dijk}, S.C. and Swart, {Karin M.A.} and Enneman, {Anke W.} and {van der Zwaluw}, {Nikita L.} and Brouwer-Brolsma, {Elske M.} and {van Schoor}, {Natasja M.} and M.C. Zillikens and Paul Lips and {de Groot}, {Lisette C.P.G.M.} and Albert Hofman and Witkamp, {Renger F.} and Uitterlinden, {Andr{\'e} G.} and Stricker, {Bruno H.} and {van der Velde}, Nathalie",
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Ham, AC, van Dijk, SC, Swart, KMA, Enneman, AW, van der Zwaluw, NL, Brouwer-Brolsma, EM, van Schoor, NM, Zillikens, MC, Lips, P, de Groot, LCPGM, Hofman, A, Witkamp, RF, Uitterlinden, AG, Stricker, BH & van der Velde, N 2017, 'Beta-blocker use and fall risk in older individuals: Original results from two studies with meta-analysis' British Journal of Clinical Pharmacology, vol. 83, no. 10, pp. 2292-2302. https://doi.org/10.1111/bcp.13328

Beta-blocker use and fall risk in older individuals : Original results from two studies with meta-analysis. / Ham, Annelies C.; van Dijk, S.C.; Swart, Karin M.A.; Enneman, Anke W.; van der Zwaluw, Nikita L.; Brouwer-Brolsma, Elske M.; van Schoor, Natasja M.; Zillikens, M.C.; Lips, Paul; de Groot, Lisette C.P.G.M.; Hofman, Albert; Witkamp, Renger F.; Uitterlinden, André G.; Stricker, Bruno H.; van der Velde, Nathalie.

In: British Journal of Clinical Pharmacology, Vol. 83, No. 10, 2017, p. 2292-2302.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Beta-blocker use and fall risk in older individuals

T2 - Original results from two studies with meta-analysis

AU - Ham, Annelies C.

AU - van Dijk, S.C.

AU - Swart, Karin M.A.

AU - Enneman, Anke W.

AU - van der Zwaluw, Nikita L.

AU - Brouwer-Brolsma, Elske M.

AU - van Schoor, Natasja M.

AU - Zillikens, M.C.

AU - Lips, Paul

AU - de Groot, Lisette C.P.G.M.

AU - Hofman, Albert

AU - Witkamp, Renger F.

AU - Uitterlinden, André G.

AU - Stricker, Bruno H.

AU - van der Velde, Nathalie

PY - 2017

Y1 - 2017

N2 - Aims: To investigate the association between use of β-blockers and β-blocker characteristics - selectivity, lipid solubility, intrinsic sympathetic activity (ISA) and CYP2D6 enzyme metabolism - and fall risk. Methods: Data from two prospective studies were used, including community-dwelling individuals, n = 7662 (the Rotterdam Study) and 2407 (B-PROOF), all aged ≥55 years. Fall incidents were recorded prospectively. Time-varying β-blocker use was determined using pharmacy dispensing records. Cox proportional hazard models adjusted for age and sex were applied to determine the association between β-blocker use, their characteristics - selectivity, lipid solubility, ISA and CYP2D6 enzyme metabolism - and fall risk. The results of the studies were combined using meta-analyses. Results: In total 2917 participants encountered a fall during a total follow-up time of 89529 years. Meta-analysis indicated no association between use of any β-blocker, compared to nonuse, and fall risk, hazard ratio (HR) = 0.97 [95% confidence interval (CI) 0.88-1.06]. Use of a selective β-blocker was also not associated with fall risk, HR = 0.92 (95%CI 0.83-1.01). Use of a nonselective β-blocker was associated with an increased fall risk, HR = 1.22 (95%CI 1.01-1.48). Other β-blocker characteristics including lipid solubility and CYP2D6 enzyme metabolism were not associated with fall risk. Conclusion: Our study suggests that use of a nonselective β-blocker, contrary to selective β-blockers, is associated with an increased fall risk in an older population. In clinical practice, β-blockers have been shown effective for a variety of cardiovascular indications. However, fall risk should be considered when prescribing a β-blocker in this age group, and the pros and cons for β-blocker classes should be taken into consideration.

AB - Aims: To investigate the association between use of β-blockers and β-blocker characteristics - selectivity, lipid solubility, intrinsic sympathetic activity (ISA) and CYP2D6 enzyme metabolism - and fall risk. Methods: Data from two prospective studies were used, including community-dwelling individuals, n = 7662 (the Rotterdam Study) and 2407 (B-PROOF), all aged ≥55 years. Fall incidents were recorded prospectively. Time-varying β-blocker use was determined using pharmacy dispensing records. Cox proportional hazard models adjusted for age and sex were applied to determine the association between β-blocker use, their characteristics - selectivity, lipid solubility, ISA and CYP2D6 enzyme metabolism - and fall risk. The results of the studies were combined using meta-analyses. Results: In total 2917 participants encountered a fall during a total follow-up time of 89529 years. Meta-analysis indicated no association between use of any β-blocker, compared to nonuse, and fall risk, hazard ratio (HR) = 0.97 [95% confidence interval (CI) 0.88-1.06]. Use of a selective β-blocker was also not associated with fall risk, HR = 0.92 (95%CI 0.83-1.01). Use of a nonselective β-blocker was associated with an increased fall risk, HR = 1.22 (95%CI 1.01-1.48). Other β-blocker characteristics including lipid solubility and CYP2D6 enzyme metabolism were not associated with fall risk. Conclusion: Our study suggests that use of a nonselective β-blocker, contrary to selective β-blockers, is associated with an increased fall risk in an older population. In clinical practice, β-blockers have been shown effective for a variety of cardiovascular indications. However, fall risk should be considered when prescribing a β-blocker in this age group, and the pros and cons for β-blocker classes should be taken into consideration.

KW - CYP2D6

KW - Falls

KW - Meta-analysis

KW - β-blockers

U2 - 10.1111/bcp.13328

DO - 10.1111/bcp.13328

M3 - Article

VL - 83

SP - 2292

EP - 2302

JO - British Journal of Clinical Pharmacology

JF - British Journal of Clinical Pharmacology

SN - 0306-5251

IS - 10

ER -