Optimizing treatment of diabetes and cardiovascular disease with combined alpha,beta-blockade

Curr Med Res Opin. 2005 Aug;21(8):1191-200. doi: 10.1185/030079905X53306.

Abstract

Background: Cardiovascular risk factors of the diabetic patient should be treated as aggressively as those of the nondiabetic patient who has had a myocardial infarction. beta-Blockers are established to reduce cardiovascular risk in patients with hypertension, coronary heart disease, and heart failure. Despite this benefit of beta-blockers, physicians have been reluctant to use them in patients with diabetes, in whom they are even more effective, because of the negative effects on carbohydrate and lipid metabolism.

Objective: This paper reviews (based on a Medline literature search to December 2004) the relationship between diabetes and cardiovascular risk factors, describes the metabolic consequences of insulin resistance, and discusses the impact of different beta-blockers on the treatment of cardiovascular disease in patients with diabetes.

Results: There is a large cardioprotective benefit with the use of beta-blockers in patients with diabetes; however, metabolic risks are associated with some beta-blockers. Newer, vasodilating, nonselective beta-blockers do not have the same adverse metabolic consequences observed with earlier beta-blockers. Recent evidence has shown that they have a neutral effect on metabolic parameters and lipid profile. They do not promote insulin resistance and can be used safely in heart failure patients with diabetes.

Conclusions: Nonselective vasodilating beta-blockers, such as carvedilol, may be used in patients with cardiovascular disease and diabetes without the same negative metabolic consequences seen with the use of earlier generation beta-blockers.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adrenergic alpha-Antagonists / adverse effects
  • Adrenergic alpha-Antagonists / therapeutic use*
  • Adrenergic beta-Antagonists / adverse effects
  • Adrenergic beta-Antagonists / therapeutic use*
  • Cardiovascular Diseases / complications
  • Cardiovascular Diseases / drug therapy*
  • Diabetes Complications / drug therapy*
  • Humans
  • Insulin Resistance
  • Risk Factors

Substances

  • Adrenergic alpha-Antagonists
  • Adrenergic beta-Antagonists