心衰患者服用美托洛尔比服用卡维地洛更易出现糖尿病
Heart 2007;93:968-973.New Onset Diabetes More Likely With Metoprolol Than With Carvedilol in Heart Failure
NEW YORK (Reuters Health) Aug 06 - New onset diabetes in patients with chronic heart failure is more likely to develop with metoprolol than with carvedilol, according to findings published in the August issue of Heart.
Previous studies have shown carvedilol to have a more favorable effect on glucose metabolism than other beta blockers have, the authors explain.
Dr. Christian Torp-Pedersen from Bispebjerg University Hospital, Copenhagen, Denmark and colleagues in the Carvedilol or Metoprolol European Trial (COMET) investigated whether carvedilol was associated with a different incidence of new onset diabetes compared with metoprolol in more than 3000 patients with chronic heart failure.
Patients taking carvedilol were 22% less likely to develop new onset diabetes than patients taking metoprolol, the authors report. New onset diabetes was diagnosed in 119 out of 1151 (10.3%) of patients taking carvedilol, versus 145 out of 1147 (12.6%) of patients taking metoprolol.
Diabetes-related adverse events were also 22% less likely to occur among carvedilol patients: 122 events versus 149 events.
Metoprolol remained an independent predictor of new onset diabetes in a multivariable model that included body mass index, hypertension, functional class, and other factors.
Patients treated with metoprolol also showed a significant trend for an increase in random blood glucose levels over the course of the trial, the investigators write.
Treatment with carvedilol was associated with a nonsignificant risk reduction for mortality compared with metoprolol for diabetic and nondiabetic patients, the researchers note.
In a multivariate analysis, however, treatment with metoprolol and a diagnosis of diabetes were independently associated with greater all-cause mortality.
"This study demonstrates that treatment with carvedilol is associated with less development of new onset diabetes in patients with heart failure compared with treatment with metoprolol tartrate," the authors conclude. "The study further demonstrates that not only is the prevalence of diabetes high in patients with heart failure but also the incidence is high, amounting to 10-15% over 5 years." 转贴
美托洛尔比卡维地洛更易诱发糖尿病
纽约(路透社健康)8月6日-《心脏》杂志8月刊报道，慢性心衰患者不仅糖尿病患病率高，其发病率也高，5年以上总计达到10-15%，而服用美托洛尔比服用卡维地洛更易诱发糖尿病。
丹麦哥本哈根克Bispebjerg大学医院的里斯蒂娜.托普.彼德森博士及其参加COMET的同事，研究了卡维地洛与美托洛尔在3000多名慢性心力衰竭患者中新发糖尿病的发生率有无差异。
据报道，卡维地洛组新发糖尿病的可能性比美托洛尔组低22%。卡维地洛组的1151位患者中新发糖尿病者119人（占10.3%），而美托洛尔组1147位患者中新发糖尿病者145人（占12.6%）。卡维地洛组的糖尿病相关不良事件发生率比美托洛尔组低22%，分别为122例和149例。在包括体重指数、高血压、功能级别以及其他因素的多变量模型中，美托洛尔还是新发糖尿病的一个独立预测因素。
研究者称，服用美托洛尔的患者在试验期间还表现出随机血糖明显升高的趋势。卡维地洛与美托洛尔相比，没有明显降低糖尿病和非糖尿病患者的死亡风险。然而，在多变量分析中，服用美托洛尔和诊断为糖尿病均与较高的全因死亡率独立相关。
作者最后总结道，之前有研究表明卡维地洛在糖代谢方面优于其它β-R阻滞剂。我们的研究进一步证明，服用卡维地洛的心衰患者糖尿病发生率低于服用美托洛尔者。
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