Long-Term Mortality Associated With Use of Carvedilol Versus Metoprolol in Heart Failure Patients With and Without Type 2 Diabetes: A Danish Nationwide Cohort Study.
Long-Term Mortality Associated With Use of Carvedilol Versus Metoprolol in Heart Failure Patients With and Without Type 2 Diabetes: A Danish Nationwide Cohort Study.
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DOI：
10.1161/jaha.121.021310
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发表时间：
2021-09-21
影响因子：
5.4
通讯作者：
Andersson C
中科院分区：
文献类型：
--
作者：
Schwartz B;Pierce C;Madelaire C;Schou M;Kristensen SL;Gislason GH;Køber L;Torp-Pedersen C;Andersson C
与美托洛尔相比，卡维地洛可能具有良好的降血糖特性，但目前尚不清楚卡维地洛在2型糖尿病(T2D)和射血分数降低(HFrEF)的心力衰竭患者中是否比美托洛尔有死亡率优势。使用2010年至2018年丹麦全国数据库，我们跟踪了接受卡维地洛或美托洛尔治疗的新发HFrEF患者的全原因死亡率，直到2018年底。在首次HFrEF诊断后120天开始随访，以启动指南指导的药物治疗。基线时，服用卡维地洛或美托洛尔的患者有39,260人(平均年龄70.8岁，女性占35%)，其中9355人(24%)患有T2D。卡维地洛用于2989例T2D患者(32%)和10411例非T2D患者(35%)。卡维地洛使用者的房颤患病率较低(20%对35%)，但其他特征似乎在两组之间很好地平衡。随访结束时死亡11例，306例(29%)。我们观察到卡维地洛和美托洛尔的死亡率没有差异，T2D患者的多变量调整危险比(HR)为0.97(0.90-1.05)，而非T2D患者的死亡率为1.00(0.95-1.05)，差异P=0.99。卡维地洛与美托洛尔相比，新发的T2D发生率较低；年龄、性别和日历年调整后的HR为0.83(0.75-0.91)，P<；0.0001。在有和没有T2D的HFrEF患者的当代临床队列中，与美托洛尔相比，卡维地洛与长期死亡率的降低无关。然而，卡维地洛与新发T2D的风险降低相关，这支持卡维地洛比美托洛尔具有更有利的代谢特征的断言。
Carvedilol may have favorable glycemic properties compared with metoprolol, but it is unknown if carvedilol has mortality benefit over metoprolol in patients with type 2 diabetes (T2D) and heart failure with reduced ejection fraction (HFrEF). Using Danish nationwide databases between 2010 and 2018, we followed patients with new‐onset HFrEF treated with either carvedilol or metoprolol for all‐cause mortality until the end of 2018. Follow‐up started 120 days after initial HFrEF diagnosis to allow initiation of guideline‐directed medical therapy. There were 39 260 patients on carvedilol or metoprolol at baseline (mean age 70.8 years, 35% women), of which 9355 (24%) had T2D. Carvedilol was used in 2989 (32%) patients with T2D and 10 411 (35%) of patients without T2D. Users of carvedilol had a lower prevalence of atrial fibrillation (20% versus 35%), but other characteristics appeared well‐balanced between the groups. Totally 11 306 (29%) were deceased by the end of follow‐up. We observed no mortality differences between carvedilol and metoprolol, multivariable‐adjusted hazard ratio (HR) 0.97 (0.90–1.05) in patients with T2D versus 1.00 (0.95–1.05) for those without T2D, P for difference =0.99. Rates of new‐onset T2D were lower in users of carvedilol versus metoprolol; age, sex, and calendar year adjusted HR 0.83 (0.75–0.91), P<0.0001. In a contemporary clinical cohort of HFrEF patients with and without T2D, carvedilol was not associated with a reduction in long‐term mortality compared with metoprolol. However, carvedilol was associated with lowered risk of new‐onset T2D supporting the assertion that carvedilol has a more favorable metabolic profile than metoprolol.