Is metoprolol more cardioprotective than other beta-blockers?

Heusch, Gerd; Kleinbongard, Petra

doi:10.1093/eurheartj/ehaa764

Cited by 14 publications

(8 citation statements)

References 14 publications

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“…Previous animal study demonstrated that only metoprolol, but not atenolol or propranolol, reduced infarct size and inflammation a rat model of MI 28 . Furthermore, beta-blockers which exert ancillary cardioprotective properties such as carvedilol through alpha 1-adrenoceptor blockade and antineutrophil and antioxidative actions, or nebivolol which enhances nitric oxide signalling may have additional benefit on cardioprotection 29 . Importantly, the interference of co-morbidities and co-medications with cardioprotection has been established 30 .…”

Section: Discussionmentioning

confidence: 99%

Effects of short-term bisoprolol on perioperative myocardial injury in patients undergoing non-cardiac surgery: a randomized control study

Wongcharoen

Chotayaporn

Chutikhongchalermroj

et al. 2021

Sci Rep

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The protective role of preoperative beta-blocker in patients undergoing non-cardiac surgery is unknown. We aimed to evaluate the effects of beta-blocker on perioperative myocardial injury in patients undergoing non-cardiac surgery. We consecutively enrolled 112 patients undergoing non-cardiac surgery. They were randomly allocated to receive bisoprolol or placebo given at least 2 days preoperatively and continued until 30 days after surgery. The primary outcome was incidence of perioperative myocardial injury defined by a rise of high-sensitive troponin-T (hs-TnT) more than 99th percentile of upper reference limit or a rise of hs-TnT more than 20% if baseline level is abnormal. Baseline characteristics were comparable between bisoprolol and placebo in randomized cohort Mean age was 62.5 ± 11.8 years and 76 (67.8%) of 112 patients were male. Among 112 patients, 49 (43.8%) underwent vascular surgery and 63 (56.2%) underwent thoracic surgery. The median duration of assigned treatment prior to surgery was 4 days (2–6 days). We did not demonstrate the significant difference in the incidence of perioperative myocardial injury [52.6% (30 of 57 patients) vs. 49.1% (27 of 55 patients), P = 0.706]. In addition, the incidence of intraoperative hypotension was higher in bisoprolol group than placebo group in patients undergoing non-cardiac surgery [70.2% (40 of 57 patients) vs. 47.3% (26 of 55 patients), P = 0.017]. We demonstrated that there was no statistically significant difference in perioperative myocardial injury observed between patients receiving bisoprolol and placebo who had undergone non-cardiac surgery.

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Section: Discussionmentioning

confidence: 99%

Effects of short-term bisoprolol on perioperative myocardial injury in patients undergoing non-cardiac surgery: a randomized control study

Wongcharoen

Chotayaporn

Chutikhongchalermroj

et al. 2021

Sci Rep

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“…There is a wealth of preclinical data on IS reduction by β -blockers in animal studies of I/R, although, as noted later, none have been successfully and reproducibly translated to humans. Studies in pigs have shown MRI-based evidence for cardioprotection by metoprolol ( Ibanez et al, 2007 ; Ibanez et al, 2011 ; García-Ruiz et al, 2016 ; Heusch and Kleinbongard, 2020 ; Lobo-Gonzalez et al, 2020 ), and histology-based evidence for cardioprotection by carvedilol ( Bril et al, 1992 ; Feuerstein and Ruffolo, 1995 ), atenolol, and the short-acting β -blocker landiolol ( Park et al, 2011 ). Carvedilol also reduced the area of no-reflow in pigs following I/R, assessed by myocardial contrast echocardiography ( Zhao et al, 2008 ).…”

Section: Effects Of Pharmacological Treatment Of Comorbidities On Car...mentioning

confidence: 99%

Interaction of Cardiovascular Nonmodifiable Risk Factors, Comorbidities and Comedications With Ischemia/Reperfusion Injury and Cardioprotection by Pharmacological Treatments and Ischemic Conditioning

et al. 2022

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Preconditioning, postconditioning, and remote conditioning of the myocardium enhance the ability of the heart to withstand a prolonged ischemia/reperfusion insult and the potential to provide novel therapeutic paradigms for cardioprotection. While many signaling pathways leading to endogenous cardioprotection have been elucidated in experimental studies over the past 30 years, no cardioprotective drug is on the market yet for that indication. One likely major reason for this failure to translate cardioprotection into patient benefit is the lack of rigorous and systematic preclinical evaluation of promising cardioprotective therapies prior to their clinical evaluation, since ischemic heart disease in humans is a complex disorder caused by or associated with cardiovascular risk factors and comorbidities. These risk factors and comorbidities induce fundamental alterations in cellular signaling cascades that affect the development of ischemia/reperfusion injury and responses to cardioprotective interventions. Moreover, some of the medications used to treat these comorbidities may impact on cardioprotection by again modifying cellular signaling pathways. The aim of this article is to review the recent evidence that cardiovascular risk factors as well as comorbidities and their medications may modify the response to cardioprotective interventions. We emphasize the critical need for taking into account the presence of cardiovascular risk factors as well as comorbidities and their concomitant medications when designing preclinical studies for the identification and validation of cardioprotective drug targets and clinical studies. This will hopefully maximize the success rate of developing rational approaches to effective cardioprotective therapies for the majority of patients with multiple comorbidities. Significance Statement Ischemic heart disease is a major cause of mortality; however, there are still no cardioprotective drugs on the market. Most studies on cardioprotection have been undertaken in animal models of ischemia/reperfusion in the absence of comorbidities; however, ischemic heart disease develops with other systemic disorders (e.g., hypertension, hyperlipidemia, diabetes, atherosclerosis). Here we focus on the preclinical and clinical evidence showing how these comorbidities and their routine medications affect ischemia/reperfusion injury and interfere with cardioprotective strategies.

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“…Myocardial protective drugs, such as cardiotonic agents, β-blockers, , and antiinflammatory drugs, are conducive to improving cardiac function and reducing the infarct size. However, most pharmaceuticals lack specificity to the heart, which limits their bioavailability at the lesion area.…”

Section: Introductionmentioning

confidence: 99%

“…11 Therefore, in order to protect the jeopardized patients, it is vital to save the I/R heart in time before spiral deterioration takes place, so as to avoid irreversible damage and structural destruction. 12 Myocardial protective drugs, such as cardiotonic agents, 13 βblockers, 14,15 and antiinflammatory drugs, 16 are conducive to improving cardiac function and reducing the infarct size. However, most pharmaceuticals lack specificity to the heart, which limits their bioavailability at the lesion area.…”

Section: ■ Introductionmentioning

confidence: 99%

Myocardium-Targeted Micelle Nanomedicine That Salvages the Heart from Ischemia/Reperfusion Injury

Yang

Peng

Shi

et al. 2022

ACS Appl. Mater. Interfaces

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Cardioprotective medication is the common treatment to relieve myocardial ischemia/reperfusion (I/R) injury. However, limited by the low bioavailability of therapeutic drugs, the therapeutic outcome is barely satisfactory. Because the I/R injury can enhance the permeability of the vasculature and allow the extravasation of nanoparticles into the surrounding tissue, herein we formulate the cardiotonic drug olprinone (Olp) in cross-linked micelles as the nanomedicine to achieve myocardium-targeted delivery after systematic administration. As a result, the local concentration of Olp in the injured myocardium is raised by orders of magnitude with prolonged drug duration time. The treatment successfully preserves the pumping efficiency of the heart, alleviates ventricular remodeling, and thus stops the positive feedback loop for the deteriorated cardiac function. Consequently, the myocardium-targeted nanomedicine significantly salvages the heart from I/R injury before irreversible pathological changes take place.

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Is metoprolol more cardioprotective than other beta-blockers?

Abstract: Abstract

Cited by 14 publications

References 14 publications

Effects of short-term bisoprolol on perioperative myocardial injury in patients undergoing non-cardiac surgery: a randomized control study

Effects of short-term bisoprolol on perioperative myocardial injury in patients undergoing non-cardiac surgery: a randomized control study

Interaction of Cardiovascular Nonmodifiable Risk Factors, Comorbidities and Comedications With Ischemia/Reperfusion Injury and Cardioprotection by Pharmacological Treatments and Ischemic Conditioning

Myocardium-Targeted Micelle Nanomedicine That Salvages the Heart from Ischemia/Reperfusion Injury

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