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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Abbasi F, Brown BW Jr, Lamendola C et al. (2002) Relationship between obesity, insulin resistance, and coronary heart disease risk. J Am Coll Cardiol 40:937–943
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 21:2051–2058
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 10:2227–2236
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 19:402–410
Dargie HJ (2001) Effect of carvedilol on outcome after myocardial infarction in patients with left ventricular dysfunction: the CAPRICORN randomized trial. Lancet 357:1385–1390
De Fronzo RA, Ferrannini E (1991) Insulin resistance a maltifaceted syndrome responsible for NIDDM, obesity, hypertension and dyslipidemia. Diab Care 14:173–177
Freemantle N, Cleland J, Young P et al. (1999) Beta blockade after myocardial infarction: systematic review and meta regression analysis. BMJ 26:1730–1737
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 94:2817–2825
Hamburger SA, Barone FC, Feuerstein GZ et al. (1991) Carvedilol (Kredex) reduces infarct size in canine model of myocardial infarction. Pharmacology 43:113–120
Jacob S, Balletshofer B, Henriksen EJ et al. (1999) Beta–blocking agents in patients with insulin resistance: effects of vasodilating beta blockers. Blood Pres 8:261–268
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 11:1258–1265
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 14:489–494
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 24:362–365
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 4:501
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 298:1152–1157
Rabkin SW (1993) Mechanisms of action of adrenergic receptor blockers on lipids during antihypertensive drug treatment. J Clin Pharmacol 33:286–291
Reaven GM (1998) Role of insulin resistance in human disease. Diabetes 37:1595–1607
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 4:445–453
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; 14:175–180
Rocchini AP, Moorehead C, Katch V et al. (1992) Forearm resistance vessel adnormalties and insulin resistance in obese adolescents. Hypertension 19:615–620
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 93:920–922
Sokolov EI (2002) Hyperinsulinemia and insulin resistance in pathogenesis of atherosclerosis and ischemic heart disease. Ter Arkh 74:40–43
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Basat, O., Ucak, S., Seber, S. et al. After myocardial infarction carvedilol improves insulin resistance compared to metoprolol. Clin Res Cardiol 95, 99–104 (2006). https://doi.org/10.1007/s00392-006-0336-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00392-006-0336-4