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Effects of metoprolol and carvedilol on preexisting and new on-set diabetes in patients with chronic heart failure ¡V data from the Carvedilol or metoprolol European Trial (COMET)
  1. Christian Torp-Pedersen (ctp{at}heart.dk)
  1. Bispebjerg University Hospital, Denmark
    1. Marco Metra (metramarco{at}libero.it)
    1. Universita de Brescia, Italy
      1. Andrew Charlesworth (a.charlesworth{at}ncrl.co.uk)
      1. Nottingham Clinical Research Group, United Kingdom
        1. Phillip Spark (p.spark{at}ncrl.co.uk)
        1. Nottingham Clinical Research Group, United Kingdom
          1. Mary Ann Lukas (mary.ann.lukas{at}gsk.com)
          1. GlaxoSmithKline, United States
            1. Philip A Poole-Wilson (p.poole-wilson{at}imperial.ac.uk)
            1. Imperial College London, United Kingdom
              1. Karl Swedberg (karl.swedberg{at}hjl.gu.se)
              1. Sahlgrenska University Hospital, Sweden
                1. John G Cleland (j.g.cleland{at}hull.ac.uk)
                1. University of Hull, United Kingdom
                  1. Andrea Di Lenarda (dilenar{at}univ.trieste.it)
                  1. Ospedale de Cattinara, Italy
                    1. Willem Remme (w.j.remme{at}sticares.org)
                    1. Sticares Cardiovascular Research, Netherlands
                      1. Armin Scherhaug (armin.scherhag{at}roche.com)
                      1. Hoffman La Roche, Switzerland

                        Abstract

                        Objective Beta-blocker therapy may worsen glucose metabolism. We studied the development of new onset diabetes in a large cohort of heart failure patients treated with either metoprolol or carvedilol.

                        Design Prospective and retrospective analysis of a controlled clinical trial.

                        Setting Multinational multicenter study

                        Patients 3029 patients with chronic heart failure.

                        Interventions Randomly assigned treatment with carvedilol (n=1511, target dose 50 mg daily) or metoprolol tartrate (n=1518, target dose 100 mg daily).

                        Results Diabetic events (diabetic coma, peripheral gangrene, diabetic foot, de-creased glucose tolerance or hyperglycemia) and new onset diabetes (clinical di-agnosis, repeated high random glucose level or glucose lowering medication) were assessed in 2298 patients without diabetes at baseline. Diabetic events oc-curred in 122/1151 (10.6%) patients in the carvedilol group and 149/1147 (13.0%) patients in the metoprolol group (hazard ratio (HR) 0.78; 95% confi-dence interval (CI) 0.61-0.99, p=0.039). New onset diabetes was diagnosed in 119/1151 (10.4%) versus 145/1147 (12.6%) cases in the carvedilol and metoprolol treatment groups (HR 0.78, CI 0.61-0.998, p=0.048). Patients with diabetes at baseline had an increased mortality, compared to non-diabetics (45.3% versus, 33.9%; HR 1.45, CI 1.28-1.65). Both diabetics and non-diabetics at baseline had a similar reduction in mortality with carvedilol compared to metoprolol (RR 0.85; CI 0.69-1.06 and RR 0.82; CI, 0.71-0.94, respectively).

                        Conclusion This study demonstrates both a high prevalence and incidence of diabetes in patients with heart failure over a course of 5 years. New onset diabe-tes was more likely to occur during treatment with metoprolol than during treat-ment with carvedilol.

                        • beta adrenergic receptor antagonists
                        • carvedilol
                        • diabetes mellitus
                        • heart failure
                        • metoprolol

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