Objective

Is prior beta blocker (BB) use associated with reduced odds of the clinical incidence of leiomyomas?

What is known already

In-vitro and in-vivo evidence has supported the role of beta receptor blockade in reducing leiomyoma cell proliferation and growth. However, no population-based study to date has investigated this potential association.

Study design, size, duration

A nested case-control study was conducted in a population of women aged 18–65 with arterial hypertension (n = 699,966). Cases (n = 18,918) with a leiomyoma diagnosis were matched to controls (n = 681,048) with no such diagnosis at a 1:36 ratio by age and region of origin within the United States.

Participants/materials, setting, methods

This population was assembled from the Truven Health MarketScan® Research Database, which includes health insurance claims from January 1st, 2012 to December 31st, 2017. Prior use of BB was determined from outpatient drug claims and leiomyoma development was indicated by a first-time diagnosis code. We conducted a conditional logistic regression to determine the odds of uterine fibroid development in women with prior use of BB compared to women with no such history. We then conducted subset analyses, stratifying the women by age group and by type of BB.

Results

Women on a BB experienced 15% reduced odds of developing clinically recognized leiomyoma compared to non-users (OR 0.85, 95% CI 0.76–0.94). This association was significant for the 30–39 age group (OR 0.61, 95% CI 0.40–0.93) but no other age group. Of the BBs, propranolol (OR 0.58, 95% CI 0.36–95) demonstrated a significant association with reduced leiomyoma incidence and metoprolol (OR 0.82, 95% CI 0.70–0.97) was associated with lower uterine fibroid incidence after adjustment for comorbidities.

Conclusions

Hypertensive women with prior BB use experienced reduced odds of developing clinically recognized leiomyoma compared to non-users. A key predisposing risk factor for uterine leiomyoma is elevated blood pressure. Thus, the results of this analysis may have clinical relevance to women with hypertension, as the use of this drug may introduce a dual benefit of managing hypertension as well as curbing an increased risk of leiomyomas.

中文翻译：

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β受体阻滞剂可降低高血压女性子宫肌瘤的发病率

客观的

既往使用β受体阻滞剂（BB）是否与平滑肌瘤临床发病率降低相关？

已知的情况

体外和体内证据支持β受体阻断在减少平滑肌瘤细胞增殖和生长中的作用。然而，迄今为止还没有基于人群的研究调查过这种潜在的关联。

研究设计、规模、持续时间

一项巢式病例对照研究在 18-65 岁患有动脉高血压的女性群体中进行（n = 699,966）。在美国，诊断为平滑肌瘤的病例 (n = 18,918) 与未诊断为平滑肌瘤的病例 (n = 681,048) 进行匹配，按年龄和原籍地区划分，比例为 1:36。

参与者/材料、设置、方法

该人群来自 Truven Health MarketScan® 研究数据库，其中包括 2012 年 1 月 1 日至 2017 年 12 月 31 日的健康保险索赔。先前使用 BB 是根据门诊药物索赔确定的，平滑肌瘤的发展是通过首次诊断 来确定的代码。我们进行了条件逻辑回归，以确定既往使用过 BB 的女性与没有此类病史的女性相比，发生子宫肌瘤的几率。然后我们进行了子集分析，按年龄组和 BB 类型对女性进行分层。 

结果

与未使用 BB 的女性相比，使用 BB 的女性患临床公认的平滑肌瘤的几率降低了 15%（OR 0.85，95% CI 0.76–0.94）。这种关联在 30-39 岁年龄组中显着（OR 0.61，95% CI 0.40-0.93），但在其他年龄组中没有显着性。在 BB 中，普萘洛尔（OR 0.58，95% CI 0.36-95）与降低平滑肌瘤发病率显着相关，美托洛尔（OR 0.82，95% CI 0.70-0.97）在调整合并症后与降低子宫肌瘤发病率相关。

结论

与未使用过 BB 的女性相比，曾使用过 BB 的高血压女性患上临床公认的平滑肌瘤的几率降低。子宫肌瘤的一个关键诱发因素是血压升高。因此，该分析的结果可能与患有高血压的女性具有临床相关性，因为使用这种药物可能会带来控制高血压和抑制平滑肌瘤风险增加的双重益处。