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Clinical Research in Cardiology

, Volume 95, Issue 2, pp 99–104 | Cite as

After myocardial infarction carvedilol improves insulin resistance compared to metoprolol

  • Okcan BasatEmail author
  • Sema Ucak
  • Selcuk Seber
  • Erkan Oztekin
  • Yuksel Altuntas
ORIGINAL PAPER

Summary

Principles

Both carvedilol and metoprolol have cardioprotective effects and decrease infarct size in myocardium. We compared effects of carvedilol and metoprolol on insulin resistance and serum lipid levels after myocardial infarction.

Methods

Fiftynine patients aged between 30 and 70 and BMI = 25–30 kg/m2, who were diagnosed with myocardial infarction with ST segment elevation, were considered to be eligible for the study. Patients were randomly allocated to two different therapy protocols. Metoprolol 100 mg bid or carvedilol 25 mg bid was added to their standardized therapy regimen. Baseline to week 4 and 12, fasting blood glucose, serum lipid profile, BMI, C–peptide, insulin and homeostasis model assessment of insulin resistance (HOMA–IR) were measured.

Results

After 12 weeks of metoprolol therapy HOMA–IR, insulin and C–peptide levels were significantly higher (p<0.05 for all) and total cholesterol and triglyceride levels decreased significantly (p < 0.05 for all) compared to baseline. After 12 weeks of carvedilol therapy HOMA–IR, insulin and C–peptide (p < 0.05 for all), total cholesterol and triglyceride (p = 0.001 for all) decreased significantly compared to baseline. Carvedilol provided more decrease in total cholesterol and LDL levels than metoprolol (p = 0.043 and p = 0.021, respectively).

Conclusions

In patients after myocardial infarction, carvedilol added to background therapy improved insulin resistance and lipid profile.

Key words

Myocardial infarction carvedilol metoprolol insulin resistance 

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References

  1. 1.
    Abbasi F, Brown BW Jr, Lamendola C et al. (2002) Relationship between obesity, insulin resistance, and coronary heart disease risk. J Am Coll Cardiol 40:937–943CrossRefPubMedGoogle Scholar
  2. 2.
    Arad Y, Newstein D, Cadet F et al. (2001) Association of multiple risk factors and insulin resistance with increased prevalance of asymptomatic coronary artery disease by an electron– beam computed tomographic study. Arterioscler Thromb Vasc Biol 21:2051–2058PubMedGoogle Scholar
  3. 3.
    Bakris GL, Fonseca V, Katholi RE et al. GEMINI Investigators (2004) Metabolic effects of carvedilol vs metoprolol in patients with type 2 diabetes mellitus and hypertension: a randomized controlled trial. JAMA 10:2227–2236Google Scholar
  4. 4.
    Bavenholm P, de Faire U, Landou C et al. (1998) Progression of coronary artery disease in young male post–infarction patients is linked to disturbances of carbohydrate and lipoprotein metabolism and to impaired fibrinolytic function. Eur Heart J 19:402–410PubMedGoogle Scholar
  5. 5.
    Dargie HJ (2001) Effect of carvedilol on outcome after myocardial infarction in patients with left ventricular dysfunction: the CAPRICORN randomized trial. Lancet 357:1385–1390PubMedGoogle Scholar
  6. 6.
    De Fronzo RA, Ferrannini E (1991) Insulin resistance a maltifaceted syndrome responsible for NIDDM, obesity, hypertension and dyslipidemia. Diab Care 14:173–177Google Scholar
  7. 7.
    Freemantle N, Cleland J, Young P et al. (1999) Beta blockade after myocardial infarction: systematic review and meta regression analysis. BMJ 26:1730–1737Google Scholar
  8. 8.
    Gilbert EM, Abraham WT, Olsen S et al. (1996) Comparative hemodynamic, left ventricular functional, and antiadrenergic effects of chronic treatment with metoprolol versus carvedilol in the failing heart. Circulation 94:2817–2825PubMedGoogle Scholar
  9. 9.
    Hamburger SA, Barone FC, Feuerstein GZ et al. (1991) Carvedilol (Kredex) reduces infarct size in canine model of myocardial infarction. Pharmacology 43:113–120PubMedGoogle Scholar
  10. 10.
    Jacob S, Balletshofer B, Henriksen EJ et al. (1999) Beta–blocking agents in patients with insulin resistance: effects of vasodilating beta blockers. Blood Pres 8:261–268Google Scholar
  11. 11.
    Jacob S, Rett K, Henriksen EJ (1998) Antihypertensive therapy and insulin sensitivity: do we have to redefine the role of beta–blocking agents? Am J Hypertens 11:1258–1265CrossRefPubMedGoogle Scholar
  12. 12.
    Jacob S, Rett K, Wicklmayr M et al. (1996) Differential effect of chronic treatment with two beta–blocking agents on insulin sensitivity: the carvedilol– metoprolol study. J Hypertens 14:489–494PubMedGoogle Scholar
  13. 13.
    Katsuki A, Sumida Y, Gabazza EC et al. (2001) Homeostasis model assessment is a reliable indicator of insulin resistance during follow–up of patients with type 2 diabetes. Diabetes Care 24:362–365PubMedGoogle Scholar
  14. 14.
    Otterstad J, Ford I (2002) The effect of carvedilol in patients with impaired left ventricular systolic function following an acute myocardial infarction. How do the treatment effects on total mortality and recurrent myocardial infarction in CAPRICORN compare with previous beta blocker trials? Eur J Heart Fail 4:501PubMedGoogle Scholar
  15. 15.
    Pollare T, Lithell H, Selinus I et al. (1989) Sensitivity to insulin during treatment with atenolol and metoprolol: a randomized, double blind stud of effects on carbohydrate and lipoprotein metabolism in hypertensive patients. BMJ 298:1152–1157PubMedGoogle Scholar
  16. 16.
    Rabkin SW (1993) Mechanisms of action of adrenergic receptor blockers on lipids during antihypertensive drug treatment. J Clin Pharmacol 33:286–291PubMedGoogle Scholar
  17. 17.
    Reaven GM (1998) Role of insulin resistance in human disease. Diabetes 37:1595–1607Google Scholar
  18. 18.
    Refsgaard J, Thomsen C, Andreasen F et al. (2002) Carvedilol does not alter the insulin sensitivity in patients with congestive heart failure. Eur J Heart Fail 4:445–453PubMedGoogle Scholar
  19. 19.
    Reneland R, Alvarez E, Andersson PE et al. (2000) Induction of insulin resistance by beta–blockade but not ACE–inhibition: long–term treatment with atenolol or trandolapril. J Hum Hypertens; 14:175–180CrossRefPubMedGoogle Scholar
  20. 20.
    Rocchini AP, Moorehead C, Katch V et al. (1992) Forearm resistance vessel adnormalties and insulin resistance in obese adolescents. Hypertension 19:615–620PubMedGoogle Scholar
  21. 21.
    Sekiguchi M, Kurabayashi M, Adachi H et al. (2004) Usefulness of insulin resistance measured by homeostasis model assessment in predicting restenosis after coronary stent placement in nondiabetic patients. Am J Cardiol 93:920–922Google Scholar
  22. 22.
    Sokolov EI (2002) Hyperinsulinemia and insulin resistance in pathogenesis of atherosclerosis and ischemic heart disease. Ter Arkh 74:40–43 PubMedGoogle Scholar

Copyright information

© Steinkopff-Verlag 2006

Authors and Affiliations

  • Okcan Basat
    • 1
    • 2
    Email author
  • Sema Ucak
    • 1
  • Selcuk Seber
    • 1
  • Erkan Oztekin
    • 1
  • Yuksel Altuntas
    • 1
  1. 1.Division of Endocrinology, Metabolism & Diabetes, Department of Internal MedicineSisli Etfal Education and Research HospitalIstanbulTurkey
  2. 2.Levaziym Mahallesi Aktas SitesiLevent-IstanbulTurkey

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