Efficacy and tolerability of the long‐term administration of carvedilol in patients with chronic heart failure with and without concomitant diabetes mellitus

Abstract

Background: Diabetes is frequently associated with heart failure and is an independent risk factor for an increased mortality and morbidity. Beta-blockers are traditionally regarded as relatively contraindicated in patients with diabetes mellitus. Aim of the study: To assess the efficacy and tolerability of carvedilol administration in patients with heart failure and concomitant diabetes. Methods and results: One hundred ninety-three patients (68 diabetics, 125 non-diabetics) with chronic heart failure were assessed by radionuclide ventriculography, cardiopulmonary exercise testing and right heart catheterization before and after 12 months of maintenance carvedilol treatment (mean dose, 40"19 mg daily). Diabetic patients were older and with a lower peak VO , 2 compared with non-diabetics. Long-term carvedilol administration was associated with an improvement in left ventricular function, clinical symptoms, resting and exercise hemodynamic parameters compared to baseline, with no significant difference between the diabetic and the non-diabetic patients. The incidence of adverse effects was also similar between the two groups. Diabetics had higher all-cause mortality with a similar mortality and hospitalization rate, compared to non-diabetics during 33"20 months of follow-up. Conclusion: Concomitant diabetes does not influence the efficacy and tolerability of carvedilol administration in patients with chronic heart failure.

Long‐term outcome in diabetic heart failure patients treated with cardiac resynchronization therapy

“…Consistent with these data, about 40% of our advanced HF patients referred for and treated with CRT had diabetes mellitus. In good agreement with previous reports [31,32], our diabetic patients were sicker than non‐diabetic ones and presented with a significantly higher prevalence of permanent atrial fibrillation and renal function impairment, larger left ventricles, as well as higher pulmonary artery systolic pressure. These pathophysiological findings may be related to interstitial fibrotic tissue and alterations in myofibrillar proteins, which are frequently observed in diabetic patients.…”

“…Our findings confirm and expand on the data by Kies et al [19] with less diabetic HF patients, and from the CARE‐HF study [20] collected over a comparable period of time. Putting these results into the context of other therapies, it is of interest to note that treatment with carvedilol in a population of diabetic HF patients similar to ours improved functional capacity and induced ventricular structural changes of similar magnitude to those observed in our diabetic HF patients over a comparable follow‐up time [31,32]. This further suggests that CRT may help restore responsiveness to pharmacological therapy, underscoring the potential value of a synergistic device‐plus‐drugs approach.…”

Clinical trials update from the American Heart Association meeting: ACORN‐CSD, primary care trial of chronic disease management, PEACE, CREATE, SHIELD, A‐HeFT, GEMINI, vitamin E meta‐analysis, ESCAPE, CARP, and SCD‐HeFT cost‐effectiveness study

“…There were more problems with bradycardia in those assigned to metoprolol [16]. It is unclear as to what extent the difference observed is due to dose or drug, although its findings are in keeping with other studies in heart failure [17,18].…”

Carvedilol in the treatment of elderly patients with chronic heart failure

“…β-blockers are often reported anecdotally to worsen diabetic control and can blunt the symptoms of hypoglycemia. However, carvedilol is as well tolerated in non-diabetics as in diabetics (Nodari et al 2003), leads to a decrease in insulin resistance (Ferrua et al 2005), and no increase of glycosylated hemoglobin (HbA1c). Metoprolol, on the other hand, had no effect on insulin resistance and was associated with an increase in HbA1c level (Kveiborg et al 2006; Bakris et al 2004).…”