Re: NYT article on diabetes T2

Jim Chinnis <jchinnis@xxxxxxxxxxxxxxxx> wrote in part:

Jackie Patti <jpatti@xxxxxxxx> wrote in part:

Jim Chinnis wrote:
Jackie Patti <jpatti@xxxxxxxx> wrote in part:

I'm kinda surprised beta-blockers aren't more controversial than statins
here since they raise bg.

Not all do. Which one are you taking?

Metoprolol (generic). I don't see anything specific in the prescribing
info for Lopressor except a warning of "unstable diabetes" (as opposed
to the stable kind?). I also see warnings on the patient info to tell
your doctor if you're diabetic, so I assume it is one of the baddies.

Carvedilol has been shown to have no impact on bg or other metabolic
parameters. You might ask your doc about taking that instead.

I am currently tapering off atenolol, the king of the "baddies," after
almost 20 years on it. If it turns out that I need a beta blocker, I'll
switch to a low dose of carvedilol.

This just came out, adding more and rather powerful support for carvedilol
against metoprolol:

Eur J Heart Fail. 2007 Aug 21; [Epub ahead of print]

Effect of carvedilol and metoprolol on the mode of death in patients
with heart failure.

Remme WJ, Cleland JG, Erhardt L, Spark P, Torp-Pedersen C, Metra M,
Komajda M, Moullet C, Lukas MA, Poole-Wilson P, Di Lenarda A, Swedberg K.
Sticares Cardiovascular Research Foundation, P.O. Box 882, 3160 AB
Rhoon, The Netherlands.

BACKGROUND: In the COMET study, carvedilol improved survival compared to
metoprolol tartrate in 3029 patients with NYHA II-IV heart failure and
EF <35%, followed for an average of 58 months. AIMS: To evaluate whether
the effect on overall mortality was specific for a particular mode of
death. This may help to identify the mechanism of the observed
difference. METHODS: Of the 1112 total deaths, 972 were adjudicated as
cardiovascular, including 480 sudden, 365 circulatory failure (CF) and
51 stroke deaths. For each mode of death, the effect of pre-specified
baseline variables was assessed, including sex, age, NYHA class,
aetiology, heart rate, systolic blood pressure, EF, atrial fibrillation,
previous myocardial infarction or hypertension, renal function,
concomitant medication, and study treatment allocation. RESULTS: In
multivariate Cox regression analyses, compared to metoprolol, carvedilol
reduced cardiovascular (RR 0.80, CI 0.7-0.91, p=0.0009), sudden (RR
0.77, CI 0.64-0.93, p=0.0073) and stroke deaths (RR 0.37, CI 0.19-0.71,
p=0.0027) with a non-significant trend for CF death (RR 0.83, CI
0.66-1.04, p=0.07). Treatment benefit with carvedilol did not differ
between modes of death, except for a greater reduction in stroke death
with carvedilol (competing risk analysis, p=0.0071 vs CF death). There
were no interactions between treatment allocation and baseline
characteristics. CONCLUSION: Mortality reduction with carvedilol
compared to metoprolol appears relatively non-specific and could be
consistent with a superior effect of carvedilol on cardiac function,
arrhythmias or, in view of the greater reduction in stroke deaths, on
vascular events.
PMID: 17716943 [PubMed - as supplied by publisher]
--
Jim Chinnis Warrenton, Virginia, USA
.

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