β2-adrenoreceptor medications and risk of Parkinson disease.
β2-adrenoreceptor medications and risk of Parkinson disease.
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DOI：
10.1002/ana.25341
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发表时间：
2018-11
影响因子：
11.2
通讯作者：
Racette BA
中科院分区：
文献类型：
--
作者：
Searles Nielsen S;Gross A;Camacho-Soto A;Willis AW;Racette BA
最近的一项研究观察到与β2-肾上腺素受体拮抗剂普萘洛尔相关的帕金森病（PD）风险增加两倍，而β2-肾上腺素受体激动剂沙丁胺醇的PD风险显著降低。我们研究了这些药物的临床适应症，即震颤和吸烟相关的肺部疾病，是否可以解释这些相关性。在2009年对美国医疗保险受益人进行的一项大型、基于人群的病例对照研究中，诊断代码、程序代码和处方数据（48，295例偶发PD病例，52，324例对照），我们检查了与使用选定β拮抗剂相关的PD风险（普萘洛尔、卡维地洛、美托洛尔）、β2激动剂沙丁胺醇和用于相同临床适应症的其他药物（扑米酮、吸入性皮质类固醇）。我们调整了人口统计学，吸烟和医疗保健的总体使用。然后，我们还检查了调整临床适应症和应用药物暴露滞后的效果。普萘洛尔似乎增加PD风险（比值比[OR]=3.62，95%置信区间[CI] 3.31-3.96）。当我们校正PD诊断/参考日期前的震颤或异常不自主运动和普萘洛尔暴露滞后时，相关性为0.97（95%CI 0.80-1.18）。扑米酮也用于震颤，对这种调整和滞后同样敏感。不适用于震颤的β拮抗剂似乎可降低PD风险（卡维地洛OR=0.77，95% CI 0.73-0.81;美托洛尔OR=0.94，95% CI 0.91-0.97），并且对适应症和滞后调整不敏感。沙丁胺醇和吸入性糖皮质激素均与PD风险无关。β2-肾上腺素受体激动剂和拮抗剂似乎不会改变PD风险。
A recent study observed a two-fold greater risk of Parkinson disease (PD) in relation to the β2-adrenoreceptor antagonist propranolol and a markedly lower risk of PD for the β2-adrenoreceptor agonist salbutamol. We examined whether confounding by clinical indication for these medications, i.e. tremor and smoking-related pulmonary conditions, explained these associations. In a large, population-based case-control study of United States Medicare beneficiaries in 2009 with diagnosis codes, procedure codes, and prescription data (48,295 incident PD cases, 52,324 controls), we examined the risk of PD in relation to use of selected β antagonists (propranolol, carvedilol, metoprolol), the β2 agonist salbutamol, and other medications used for the same clinical indications (primidone, inhaled corticosteroids). We adjusted for demographics, smoking, and overall use of medical care. We then examined the effect of also adjusting for clinical indication and applying medication exposure lagging. Propranolol appeared to increase PD risk (odds ratio [OR]=3.62, 95% confidence interval [CI] 3.31–3.96). When we adjusted for tremor or abnormal involuntary movement prior to the PD diagnosis/reference date and lagged propranolol exposure, the association was 0.97 (95% CI 0.80–1.18). Primidone, also used for tremor, was similarly sensitive to this adjustment and lagging. β antagonists not indicated for tremor appeared to reduce PD risk (carvedilol OR=0.77, 95% CI 0.73–0.81; metoprolol OR=0.94, 95% CI 0.91–0.97) and were insensitive to adjustment for indications and lagging. Neither salbutamol nor inhaled corticosteroids were consistently associated with PD risk. β2-adrenoreceptor agonists and antagonists do not appear to alter PD risk.
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影响因子：
11.2
作者：
Camacho-Soto A;Warden MN;Searles Nielsen S;Salter A;Brody DL;Prather H;Racette BA
通讯作者：
Racette BA
影响因子：
11.2
作者：
Hernán, MA;Takkouche, B;Gestal-Otero, JJ
通讯作者：
Gestal-Otero, JJ
影响因子：
9.9
作者：
Nielsen, Susan Searles;Warden, Mark N.;Racette, Brad A.
通讯作者：
Racette, Brad A.
影响因子：
--
作者：
KOLLER, WC;BIARY, N
通讯作者：
BIARY, N
影响因子：
4.7
作者：
Selya, Arielle S.;Oancea, Sanda Cristina;Thapa, Sunita
通讯作者：
Thapa, Sunita