Abstract | OBJECTIVES: BACKGROUND: Full adrenergic blockade by carvedilol and additional (e.g., antioxidative) properties may lead to vascular protection relative to beta-1 blockade alone, and contribute to its efficacy in HF treatment. METHODS: RESULTS: The effect of carvedilol on cardiovascular death improved consistently in subgroups with prespecified baseline variables. Myocardial infarctions were reported in 69 carvedilol and 94 metoprolol patients (hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.52 to 0.97, p = 0.03). Cardiovascular death or nonfatal MI combined were reduced by 19% in carvedilol (HR 0.81, 95% CI 0.72 to 0.92, p = 0.0009 vs. metoprolol). Unstable angina was reported as an adverse event in 56 carvedilol and in 77 metoprolol patients (HR 0.71, 95% CI 0.501 to 0.998, p = 0.049). A stroke occurred in 65 carvedilol and 80 metoprolol patients (HR 0.79, 95% CI 0.57 to 1.10). Stroke or MI combined occurred in 130 carvedilol and 168 metoprolol patients (HR 0.75, 95% CI 0.60 to 0.95, p = 0.015), and fatal MI or fatal stroke occurred in 34 carvedilol and in 72 metoprolol patients (HR 0.46, 95% CI 0.31 to 0.69, p = 0.0002). Death after a nonfatal MI or stroke occurred in 61 of 124 carvedilol and in 106 of 160 metoprolol patients (HR 0.66, 95% CI 0.48 to 0.90, p = 0.0086). CONCLUSIONS:
Carvedilol improves vascular outcomes better than metoprolol. These results suggest a ubiquitous protective effect of carvedilol against major vascular events.
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Authors | Willem J Remme, Christian Torp-Pedersen, John G F Cleland, Philip A Poole-Wilson, Marco Metra, Michel Komajda, Karl Swedberg, Andrea Di Lenarda, Phillip Spark, Armin Scherhag, Christine Moullet, Mary Ann Lukas |
Journal | Journal of the American College of Cardiology
(J Am Coll Cardiol)
Vol. 49
Issue 9
Pg. 963-71
(Mar 06 2007)
ISSN: 1558-3597 [Electronic] United States |
PMID | 17336720
(Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Adrenergic beta-Antagonists
- Carbazoles
- Propanolamines
- Carvedilol
- Metoprolol
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Topics |
- Adrenergic beta-Antagonists
(therapeutic use)
- Angina, Unstable
(etiology, prevention & control)
- Carbazoles
(therapeutic use)
- Carvedilol
- Death, Sudden, Cardiac
(etiology, prevention & control)
- Double-Blind Method
- Female
- Heart Failure
(complications, drug therapy)
- Humans
- Male
- Metoprolol
(therapeutic use)
- Middle Aged
- Myocardial Infarction
(etiology, prevention & control)
- Propanolamines
(therapeutic use)
- Stroke
(etiology, prevention & control)
- Survival Analysis
- Treatment Outcome
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