Type of β-blocker use among patients with versus without diabetes after myocardial infarction

Abstract

Background Discharge beta-blocker prescription after myocardial infarction (MI) is recommended for all eligible patients. Numerous beta-blocker choices are presently available with variable glycometabolic effects, which could be an important consideration in patients with diabetes mellitus (DM). Whether patients with DM preferentially receive beta-blockers with favorable metabolic effects after MI and if this choice is associated with better glycemic control post-discharge is unknown. Methods Among patients from 24 US hospitals enrolled in an MI registry (2005–08), we investigated the frequency of “DM-friendly” beta-blocker prescription at discharge by DM status. Beta-blockers were classified as DM-friendly (e.g., carvedilol, labetalol), or non-DM-friendly (e.g., metoprolol, atenolol), based on their effects on glycemic control. Hierarchical, multivariable logistic regression examined the association of DM with DM-friendly beta-blocker use. Among DM patients, we examined the association of DM-friendly beta-blockers with worsened glycemic control at 6 months after MI. Results Of 4031 MI patients, 1382 (34%) had DM. Beta-blockers were prescribed at discharge in 93% of patients. DM-friendly beta-blocker use was low regardless of DM status, although patients with DM were more likely to be discharged on a DM-friendly beta-blocker compared with patients without DM (13.5% vs. 10.3%, p=0.003), an association that remained after multivariable adjustment (OR 1.41, 95% CI 1.13–1.77). There was a trend toward a lower risk of worsened glucose control at 6 months in DM patients prescribed DM-friendly vs. non-friendly beta-blockers (RR 0.80, 95% CI 0.60–1.08). Conclusion The vast majority of DM patients were prescribed non-DM friendly beta-blockers—a practice that was associated with a trend towards worse glycemic control post-discharge. While in need of further confirmation in larger studies, our findings highlight an opportunity to improve current practices of beta-blockers use in patients with DM.

Recognition of Incident Diabetes Mellitus During an Acute Myocardial Infarction

“…For example, an AMI patient with multivessel disease and DM may be preferentially treated with bypass graft surgery instead of multivessel stenting. In addition, multiple pharmacological treatment decisions during the AMI are potentially influenced by the presence or absence of DM, including initiation of angiotensin converting enzyme inhibitors in the AMI patient with normal left ventricular function, selection of a beta-blocker that is metabolically favorable, 22 addition of aldosterone inhibitors in patients with left ventricular dysfunction in the absence of clinical heart failure, 16 or use of more potent antiplatelet agents (e.g., prasugrel or ticagrelor). 23 So, at multiple steps during the AMI hospitalization, the diagnosis of concomitant DM has the potential to influence many key treatment decisions during the AMI, making the prompt recognition of underlying DM important beyond the long-term implications on glycemic control.…”

The Impact of Cardiovascular Drugs on Glycemic Control: A Review

“…However, despite these findings of a favorable glycometabolic profile of particular beta-blockers with at least equivalent cardioprotective effects, most patients with Type 2 diabetes are not prescribed DM-friendly beta-blockers following AMI, a practice that was associated with poorer glycemic control at follow-up. 19 In the same study, DM-friendly β-blocker prescription at discharge was associated with a trend toward a lower risk of worsened glucose control at 6 months after AMI (RR 0.80, 95% CI 0.60-1.08). 19 …”

“…19 In the same study, DM-friendly β-blocker prescription at discharge was associated with a trend toward a lower risk of worsened glucose control at 6 months after AMI (RR 0.80, 95% CI 0.60-1.08). 19 …”

“…Highlighting the differences in glycemic effects across different CVD medications is highly relevant, as research has shown that clinicians are rarely integrating these data in their CVD treatment decisions. 19 As the population of patients with diabetes and CVD continues to increase, a greater knowledge of these drug:disease interactions will be even more critical for clinicians. In the era of precision medicine, understanding the metabolic impact of cardiovascular medications may guide decision support tool development to better optimize a medical regimen that is symbiotic to both CVD and diabetes.…”

Antiarrhythmic drugs use in elderly patients. Vaughan Williams class I and II drugs

“…В нескольких небольших исследованиях были показа-ны преимущества β-адреноблокаторов с сосудорасши-ряющими свойствами (карведилол, небиволол) перед атенололом и метопрололом по влиянию на липидный про-филь крови и метаболические показатели [44,47], а кар-ведилол и бисопролол превосходили атенолол и метопролол по способности предотвращать смертность у пожилых па-циентов (71,8±7,9 лет) c сердечной недостаточностью и вновь диагностированным сахарным диабетом [48].…”