Effect of carvedilol vs metoprolol succinate on mortality in heart failure with reduced ejection fraction

Ajam, Tarek; Ajam, Samer; Devaraj, Srikant; Mohammed, Kahee A.; Sawada, Stephen; Kamalesh, Masoor

doi:10.1016/j.ahj.2018.01.005

Cited by 15 publications

(12 citation statements)

References 24 publications

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“…The above observations are not in line with an article recently published in American Heart Journal, which reported superiority of carvedilol compared to metoprolol succinate in the largest to date group of patients with heart failure and impaired left ventricular systolic func-tion [55]. Primary analysis included 114 745 patients with heart failure treated with carvedilol or metoprolol and, after propensity score analysis, patients were matched with regard to age, sex, comorbidities, other medication and their doses, resulting in homogeneous groups of 43 941 patients in each arm of the study.…”

Section: Contcontrasting

confidence: 64%

Carvedilol – is it still the primus inter pares among b-blockers?

Ostrowska¹,

Kubica²

2018

Medical Research Journal

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Section: Contcontrasting

confidence: 64%

Carvedilol – is it still the primus inter pares among b-blockers?

Ostrowska¹,

Kubica²

2018

Medical Research Journal

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“…The improved survival of carvedilol over metoprolol succinate is consistent to our previous study. (8) From the treatment effects model, we find that the estimated average time to mortality when all matched sample were treated using low dose was 6.6. When the entire matched sample were treated with high dose of beta blocker, the average time to death was estimated to increase by 1.35 years (or 20% increase) than when all matched sample were treated using low dose of beta blocker.…”

Section: Resultsmentioning

confidence: 93%

Effect on Mortality of Higher Versus Lower β-Blocker (Metoprolol Succinate or Carvedilol) Dose in Patients With Heart Failure

Ajam

Devaraj

et al. 2018

The American Journal of Cardiology

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This study aimed to compare the effect of β-blocker dose and heart rate (HR) on mortality in patients with heart failure with reduced ejection fraction (HFrEF). The Veteran Affairs databases were queried to identify all patients diagnosed with HFrEF based on International Classification of Diseases Ninth Revision codes from 2007 to 2015 and β-blocker (carvedilol or metoprolol succinate) use. 36,168 patients on low dose β blocker were then matched with 36,168 patients on high dose β-blocker using propensity score matching. The impact of β-blocker dose and HR was assessed on overall mortality using Cox proportional hazard model. After dividing average HR into separate quartiles and adjusting for patient characteristics, high β-blocker dose was associated with lower overall mortality as compared with a low dose of β blocker (hazard ratio 0.75, 95% confidence interval 0.73 to 0.77, p <0.01) independent of the HR achieved. The results held for all 4 quartiles of average HR. A higher β-blocker dose or a lower HR were independently and jointly associated with lower mortality for all quartiles of HR. In conclusion, higher dose of β-blocker therapy and a lower achieved HR were independently associated with a reduction in mortality in HFrEF patients.

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“…Second-generation β-blockers (metoprolol and bisoprolol) are safe to use in HF but are of limited efficacy due to their selective β 1 (and not α and β 2 ) receptor blockade. 79 A more recent innovation in the treatment of diabetic HF is the use of a combination of sacubitril and valsartan. The most powerful member of this group is carvedilol, which, in addition to being a powerful anti-oxidant, selectively blocks α, β 1 and β 2 receptors, and has been shown in enhanced myocardial contractility to reverse remodelling and improve the ejection fraction in patients with HFrEF.…”

Section: Diagnosis Screening and Therapymentioning

confidence: 99%

“…77 The increase in insulin resistance that occurs with most β-blockers does not occur with carvedilol and HbA1c decreases, insulin sensitivity improves and progression to microalbuminuria occurs less frequently 78 ; therefore, carvedilol should not be withheld in patients with diabetes. 79 A more recent innovation in the treatment of diabetic HF is the use of a combination of sacubitril and valsartan. Sacubitril antagonizes the action of neprilysin, which degrades peptides including angiotensin and bradykinin.…”

Section: Diagnosis Screening and Therapymentioning

confidence: 99%

Heart failure in the patient with diabetes: Epidemiology, aetiology, prognosis, therapy and the effect of glucose‐lowering medications

Bell¹,

Goncalves

2019

Diabetes Obesity Metabolism

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In people with type 2 diabetes the frequency of heart failure (HF) is increased and mortality from HF is higher than with non-diabetic HF. The increased frequency of HF is attributable to the cardiotoxic tetrad of ischaemic heart disease, left ventricular hypertrophy, diabetic cardiomyopathy and an extracellular volume expansion resistant to atrial natriuretic peptides. Activation of the renin-angiotensin-aldosterone system and sympathetic nervous systems results in cardiac remodelling, which worsens cardiac function. Reversal of remodelling can be achieved, and cardiac function improved in people with HF with reduced ejection fraction (HFrEF) by treatment with angiotensin-converting enzyme inhibitors and β-blockers. However, with HF with preserved ejection fraction (HFpEF), only therapy for the underlying risk factors helps.Blockers of mineralocorticoid receptors may be beneficial in both HFrEF and HFpEF. Glucoselowering drugs can have a negative effect (insulin, sulphonylureas, dipeptidyl peptidase-4 inhibitors and thiazolidinediones), a neutral effect (α-glucosidase inhibitors and glucagon-like peptide-1 receptor agonists) or a positive effect (sodium-glucose co-transporter-2 inhibitors and metformin).antidiabetic drug, GLP-1 analogue, heart failure, insulin therapy, SGLT2 inhibitor, thiazolidinediones 1 | INTRODUCTION Heart failure (HF) results from structural and/or functional impairment of ventricular filling and/or ejection 1 and it is a common and serious comorbidity of type 2 diabetes. 2 In the present review we document the increased incidence of HF, and the reasons for this increase, as well as its poor prognosis in patients with diabetes.The potential therapies to both prevent and treat HF are discussed, in addition to the positive and negative effects of glucoselowering medications.Several reviews on this important subject have been recently published 3-7 ; however, this is a rapidly evolving field. An important limitation has been that HF was not a primary endpoint in most cardiovascular (CV) outcome trials, and it has been the most heterogeneously distributed outcome. | EPIDEMIOLOGYAs long ago as the Framingham Heart Study, HF was shown to be twice as common in men with diabetes and five times more common in women with diabetes between the ages of 45 and 74 years when compared with age-matched non-diabetic controls, and, in those aged ≤65 years, there was a fourfold increase in the prevalence of HF in men with diabetes and an eightfold increase in women with diabetes. 8In almost 10 000 patients with type 2 diabetes enrolled in a Health Maintenance Organization, 12% had HF at entry. Independent risk factors for the presence of HF were older age, longer duration of diabetes, use of insulin and lower body mass index (BMI). 9 In addition, those with type 2 diabetes who did not have HF at entry developed HF at a rate of 3.3% per year. The Reykjavik Study reported a 12% prevalence of HF in people with diabetes compared with 3% in people

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Effect of carvedilol vs metoprolol succinate on mortality in heart failure with reduced ejection fraction

Abstract: Patients with HFrEF taking carvedilol had improved survival as compared to metoprolol succinate. The data supports the need for furthering testing to determine optimal choice of beta blockers in patients with heart failure with reduced ejection fraction.

Cited by 15 publications

References 24 publications

Carvedilol – is it still the primus inter pares among b-blockers?

Carvedilol – is it still the primus inter pares among b-blockers?

Effect on Mortality of Higher Versus Lower β-Blocker (Metoprolol Succinate or Carvedilol) Dose in Patients With Heart Failure

Heart failure in the patient with diabetes: Epidemiology, aetiology, prognosis, therapy and the effect of glucose‐lowering medications

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