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Clinical trials have demonstrated that a long-term treatment with carvedilol,a new adrenoreceptor blocker,non-selectively antagonized β1、β2 and α1-receptor,can decrease the mortality of patients with congestive heart failure.This article reviews the effects of carvedilol in congestive heart failure.
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To study the characteristics and prognostic implications of type 2 diabetes in different heart failure entities from a nationwide perspective.This observational study comprised 30,696 heart failure patients prospectively included in the Swedish Heart Failure Registry (SwedeHF) 2003-2011 from specialist care, with mortality information available until December 2014. Patients were categorized into three heart failure entities by their left ventricular ejection fraction (heart failure with preserved ejection fraction: ⩾50%, heart failure with mid-range ejection fraction: 40%-49% and heart failure with reduced ejection fraction: <40%). All-cause mortality stratified by type 2 diabetes and heart failure entity was studied by Cox regression.Among the patients, 22% had heart failure with preserved ejection fraction, 21% had heart failure with mid-range ejection fraction and 57% had heart failure with reduced ejection fraction. The proportion of type 2 diabetes was similar, ≈25% in each heart failure entity. Patients with type 2 diabetes and heart failure with preserved ejection fraction were older, more often female and burdened with hypertension and renal impairment compared with heart failure with mid-range ejection fraction and heart failure with reduced ejection fraction patients among whom ischaemic heart disease was more common. Type 2 diabetes remained an independent mortality predictor across all heart failure entities after multivariable adjustment, somewhat stronger in heart failure with left ventricular ejection fraction below 50% (hazard ratio, 95% confidence interval; heart failure with preserved ejection fraction: 1.32 [1.22-1.43], heart failure with mid-range ejection fraction: 1.51 [1.39-1.65], heart failure with reduced ejection fraction: 1.46 [1.39-1.54]; p-value for interaction, p = 0.0049).Type 2 diabetes is an independent mortality predictor across all heart failure entities increasing mortality risk by 30%-50%. In type 2 diabetes, the heart failure with mid-range ejection fraction entity resembles heart failure with reduced ejection fraction in clinical characteristics, risk factor pattern and prognosis.
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AbstractCarvedilol is a vasodilating β-blocker with antioxidant activity, and is currently approved for use in hypertension, angina and congestive heart failure in many countries. Carvedilol is a non-selective β1-and β2-adrenoceptor antagonist, an α1-adrenoceptor antagonist (which produces vasodilation) and a potent antioxidant. The antioxidant actions of carvedilol have been demonstrated both in vitro and in vivo, including humans at therapeutic doses of the drug. Carvedilol possesses cardioprotective actions that result from the potent anti-ischaemic, antiarrhythmic and anti-apoptotic effects of the drug that have been demonstrated in a variety of experimental models of myocardial injury. In Phase III clinical trials in patients with congestive heart failure, carvedilol has been shown to reduce mortality by 65% (p < 0.0001) and to reduce hospitalisation significantly. As a result of the efficacy of carvedilol in reducing morbidity and mortality in patients with congestive heart failure, and in improving the quality of life in these patients, a new era in the management of congestive heart failure has begun.
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