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Comparing the effects of various β-blockers on cardiovascular mortality in breast cancer patients
Mantasha Tabassum1, Soumya G Chikermane2, Camille Johnson3
1Department of Pharmacological and Pharmaceutical Sciences, University of Houston College of Pharmacy, 4349 Martin Luther King Blvd, 77204, Houston, TX, USA.
Insights
Metoprolol use in older breast cancer patients was linked to a lower risk of cardiovascular death compared to carvedilol. This study compared common beta-blockers for cardiovascular mortality in this patient group.
Area of Science:
- Cardiology
- Oncology
- Pharmacology
Background:
- Cardiovascular disease is a major cause of death in breast cancer patients.
- Previous studies have not compared beta-blockers for cardiovascular mortality in this population.
Purpose of the Study:
- To compare cardiovascular mortality among older breast cancer patients using metoprolol, atenolol, or carvedilol.
Main Methods:
- Retrospective cohort study using SEER-Medicare data (2010-2015).
- Included patients aged 66+ at breast cancer diagnosis on monotherapy (metoprolol, atenolol, carvedilol).
- Used competing risk regression to analyze CV mortality risk, adjusting for covariates.
Main Results:
- Metoprolol use was associated with a 37% reduced risk of CV mortality compared to carvedilol (HR=0.63; 95% CI 0.41-0.96).
- No significant difference in CV mortality risk was found between atenolol and carvedilol users (HR=0.74; 95% CI 0.44-1.22).
Conclusions:
- Metoprolol may reduce cardiovascular mortality in breast cancer patients.
- Further research is needed to confirm these findings and elucidate the mechanism.
Background:
Cardiovascular (CV) disease is a leading cause of death in breast cancer (BC) patients due to the increased age and treatments. While individual β-blockers have been investigated to manage CV complications, various β-blockers have not been compared for their effects on CV death in this population. We aimed to compare CV mortality in older BC patients taking one of the commonly used β-blockers.
Methods:
This retrospective cohort study was conducted using the Surveillance, Epidemiology and End Results (SEER) - Medicare data (2010-2015). Patients of age 66 years or older at BC diagnosis receiving metoprolol, atenolol, or carvedilol monotherapy were included. The competing risk regression model was used to determine the risk of CV mortality in the three β-blocker groups. The multivariable model was adjusted for demographic and clinical covariates. The adjusted hazard ratio (HR) and 95% confidence intervals (CI) were reported for the risk of CV mortality.
Results:
The study cohort included 6,540 patients of which 55% were metoprolol users, 30% were atenolol users, and 15% were carvedilol users. Metoprolol was associated with a 37% reduced risk of CV mortality (P = 0.03) compared to carvedilol after adjusting for the covariates (HR = 0.63; 95% CI 0.41-0.96). No significant difference in the risk of CV mortality between atenolol and carvedilol users was observed (HR = 0.74; 95% CI 0.44-1.22).
Conclusions:
Our findings suggest that metoprolol is associated with a reduced risk of CV mortality in BC patients. Future studies are needed to confirm these findings and understand the mechanism of action.
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