Association between the use of β-adrenergic receptor agents and the development of venous leg ulcers

David J. Margolis, Ole Hoffstad, Roslyn Rivkah Isseroff

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objective: To explore an association between the use of β-adrenergic receptor agonists or antagonists and the onset of venous leg ulcers (VLUs). Design: Retrospective cohort study. Setting: Ambulatory setting of general practice in the United Kingdom. Patients: Patients followed by participating physicians. Main Outcome Measure: Onset of VLU. Results: A total of 414 887 patients registered in the General Practice Research Database met our study criteria for eligibility. Of these individuals, 62 886 were exposed to a β-adrenergic receptor agonist and 54 861 were exposed to a β-adrenergic receptor antagonist (6620 used both β-adrenergic receptor antagonists and agonists). Of those exposed to a β-adrenergic receptor agonist, 15.5% developed a VLU, whereas 18.4% of those who were not exposed developed a VLU. Of those exposed to a β-adrenergic receptor antagonist, 18.2% developed a VLU, whereas 19.9% of those not exposed developed a VLU. The odds ratio (OR) of association between β-adrenergic receptor antagonist and VLUs was 1.02 (95% confidence interval [CI], 0.99-1.04); for the association between β-adrenergic receptor agonist and VLUs, 0.84 (95% CI, 0.82-0.86). The fully adjusted ORs were 1.04 (95% CI, 0.98-1.11) and 0.44 (95% CI, 0.42-0.45), respectively. Furthermore, using propensity score models, we were able to confirm the association for β-adrenergic receptor agonist users. In addition, β-adrenergic receptor antagonist users in many of the propensity score quintiles were also protected from developing VLUs. Conclusions: A protective association between β-adrenergic receptor agonists and perhaps β-adrenergic receptor antagonists and VLUs exists. There is strong laboratory evidence to support these epidemiologic findings. The evidence in this study should not be used as a rationale for treatment of VLUs with β-adrenergic receptor agents but should be compelling for the consideration of a randomized clinical trial.

Original languageEnglish (US)
Pages (from-to)1275-1280
Number of pages6
JournalArchives of Dermatology
Volume143
Issue number10
DOIs
StatePublished - Oct 2007

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Varicose Ulcer
Leg Ulcer
Adrenergic Agents
Adrenergic Receptors
Adrenergic Agonists
Adrenergic Antagonists
Confidence Intervals
Propensity Score
General Practice
Cohort Studies
Randomized Controlled Trials
Retrospective Studies
Odds Ratio
Outcome Assessment (Health Care)
Databases

ASJC Scopus subject areas

  • Dermatology

Cite this

Association between the use of β-adrenergic receptor agents and the development of venous leg ulcers. / Margolis, David J.; Hoffstad, Ole; Isseroff, Roslyn Rivkah.

In: Archives of Dermatology, Vol. 143, No. 10, 10.2007, p. 1275-1280.

Research output: Contribution to journalArticle

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title = "Association between the use of β-adrenergic receptor agents and the development of venous leg ulcers",
abstract = "Objective: To explore an association between the use of β-adrenergic receptor agonists or antagonists and the onset of venous leg ulcers (VLUs). Design: Retrospective cohort study. Setting: Ambulatory setting of general practice in the United Kingdom. Patients: Patients followed by participating physicians. Main Outcome Measure: Onset of VLU. Results: A total of 414 887 patients registered in the General Practice Research Database met our study criteria for eligibility. Of these individuals, 62 886 were exposed to a β-adrenergic receptor agonist and 54 861 were exposed to a β-adrenergic receptor antagonist (6620 used both β-adrenergic receptor antagonists and agonists). Of those exposed to a β-adrenergic receptor agonist, 15.5{\%} developed a VLU, whereas 18.4{\%} of those who were not exposed developed a VLU. Of those exposed to a β-adrenergic receptor antagonist, 18.2{\%} developed a VLU, whereas 19.9{\%} of those not exposed developed a VLU. The odds ratio (OR) of association between β-adrenergic receptor antagonist and VLUs was 1.02 (95{\%} confidence interval [CI], 0.99-1.04); for the association between β-adrenergic receptor agonist and VLUs, 0.84 (95{\%} CI, 0.82-0.86). The fully adjusted ORs were 1.04 (95{\%} CI, 0.98-1.11) and 0.44 (95{\%} CI, 0.42-0.45), respectively. Furthermore, using propensity score models, we were able to confirm the association for β-adrenergic receptor agonist users. In addition, β-adrenergic receptor antagonist users in many of the propensity score quintiles were also protected from developing VLUs. Conclusions: A protective association between β-adrenergic receptor agonists and perhaps β-adrenergic receptor antagonists and VLUs exists. There is strong laboratory evidence to support these epidemiologic findings. The evidence in this study should not be used as a rationale for treatment of VLUs with β-adrenergic receptor agents but should be compelling for the consideration of a randomized clinical trial.",
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N2 - Objective: To explore an association between the use of β-adrenergic receptor agonists or antagonists and the onset of venous leg ulcers (VLUs). Design: Retrospective cohort study. Setting: Ambulatory setting of general practice in the United Kingdom. Patients: Patients followed by participating physicians. Main Outcome Measure: Onset of VLU. Results: A total of 414 887 patients registered in the General Practice Research Database met our study criteria for eligibility. Of these individuals, 62 886 were exposed to a β-adrenergic receptor agonist and 54 861 were exposed to a β-adrenergic receptor antagonist (6620 used both β-adrenergic receptor antagonists and agonists). Of those exposed to a β-adrenergic receptor agonist, 15.5% developed a VLU, whereas 18.4% of those who were not exposed developed a VLU. Of those exposed to a β-adrenergic receptor antagonist, 18.2% developed a VLU, whereas 19.9% of those not exposed developed a VLU. The odds ratio (OR) of association between β-adrenergic receptor antagonist and VLUs was 1.02 (95% confidence interval [CI], 0.99-1.04); for the association between β-adrenergic receptor agonist and VLUs, 0.84 (95% CI, 0.82-0.86). The fully adjusted ORs were 1.04 (95% CI, 0.98-1.11) and 0.44 (95% CI, 0.42-0.45), respectively. Furthermore, using propensity score models, we were able to confirm the association for β-adrenergic receptor agonist users. In addition, β-adrenergic receptor antagonist users in many of the propensity score quintiles were also protected from developing VLUs. Conclusions: A protective association between β-adrenergic receptor agonists and perhaps β-adrenergic receptor antagonists and VLUs exists. There is strong laboratory evidence to support these epidemiologic findings. The evidence in this study should not be used as a rationale for treatment of VLUs with β-adrenergic receptor agents but should be compelling for the consideration of a randomized clinical trial.

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