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

Background 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). Methods and Results Using Danish nationwide da...

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Autores principales:	Brian Schwartz, Colin Pierce, Christian Madelaire, Morten Schou, Søren Lund Kristensen, Gunnar H. Gislason, Lars Køber, Christian Torp‐Pedersen, Charlotte Andersson
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	carvedilol metoprolol mortality type 2 diabetes Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/1703b40dbd1b4c998254ce4df2db0a61
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spelling	oai:doaj.org-article:1703b40dbd1b4c998254ce4df2db0a612021-11-23T11:36:34ZLong‐Term Mortality Associated With Use of Carvedilol Versus Metoprolol in Heart Failure Patients With and Without Type 2 Diabetes: A Danish Nationwide Cohort Study10.1161/JAHA.121.0213102047-9980https://doaj.org/article/1703b40dbd1b4c998254ce4df2db0a612021-09-01T00:00:00Zhttps://www.ahajournals.org/doi/10.1161/JAHA.121.021310https://doaj.org/toc/2047-9980Background 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). Methods and Results 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. Conclusions 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.Brian SchwartzColin PierceChristian MadelaireMorten SchouSøren Lund KristensenGunnar H. GislasonLars KøberChristian Torp‐PedersenCharlotte AnderssonWileyarticlecarvedilolmetoprololmortalitytype 2 diabetesDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 18 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	carvedilol metoprolol mortality type 2 diabetes Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	carvedilol metoprolol mortality type 2 diabetes Diseases of the circulatory (Cardiovascular) system RC666-701 Brian Schwartz Colin Pierce Christian Madelaire Morten Schou Søren Lund Kristensen Gunnar H. Gislason Lars Køber Christian Torp‐Pedersen Charlotte Andersson 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
description	Background 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). Methods and Results 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. Conclusions 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.
format	article
author	Brian Schwartz Colin Pierce Christian Madelaire Morten Schou Søren Lund Kristensen Gunnar H. Gislason Lars Køber Christian Torp‐Pedersen Charlotte Andersson
author_facet	Brian Schwartz Colin Pierce Christian Madelaire Morten Schou Søren Lund Kristensen Gunnar H. Gislason Lars Køber Christian Torp‐Pedersen Charlotte Andersson
author_sort	Brian Schwartz
title	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
title_short	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
title_full	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
title_fullStr	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
title_full_unstemmed	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
title_sort	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
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/1703b40dbd1b4c998254ce4df2db0a61
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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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