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Carvedilol does not alter the insulin sensitivity in patients with congestive heart failure
Jens Refsgaard1, Claus Thomsen, Frederik Andreasen
1Department of Cardiology and Medicine, Aarhus Amtssygehus, Aarhus University Hospital, Tage Hansensgade 2, Denmark. jensrefsgaard@post.tele.dk
Insights
Carvedilol does not affect insulin sensitivity in patients with congestive heart failure (CHF). This study found no significant changes in insulin sensitivity (S(i)) when adding carvedilol to standard treatment for mild to moderate CHF.
Area of Science:
- Cardiology
- Endocrinology
- Pharmacology
Background:
- Congestive heart failure (CHF) is linked to insulin resistance and hyperinsulinemia.
- The beta-blocker carvedilol shows benefits in CHF patients.
- The impact of carvedilol on insulin sensitivity (S(i)) in CHF is not well understood.
Purpose of the Study:
- To determine if carvedilol treatment alters insulin sensitivity (S(i)) in patients with CHF.
- To conduct a prospective, double-blinded, placebo-controlled investigation.
Main Methods:
- Patients with mild to moderate CHF were randomized to receive carvedilol or placebo.
- Insulin and glucose responses were measured using an intravenous glucose tolerance test.
- Insulin sensitivity (S(i)) was calculated using Bergman's Minimal Model.
Main Results:
- Baseline S(i) correlated with BMI, HDL-cholesterol, triglycerides, weight, plasma urate, and maximal oxygen uptake.
- Insulin sensitivity remained unchanged in the carvedilol group compared to the placebo group.
- No significant difference in S(i) was observed between the groups (P=0.83).
Conclusions:
- Carvedilol treatment does not influence insulin sensitivity in patients with mild to moderate CHF.
- Adding carvedilol to existing therapy is metabolically neutral regarding insulin sensitivity.
Background:
Congestive heart failure (CHF) has previously been shown to be associated with insulin resistance and hyperinsulinemia. A beneficial effect of the non-selective beta-blocker carvedilol has been demonstrated in patients with CHF. However, whether the drug affects the insulin sensitivity (S(i)) is unknown.
Aims:
To investigate whether treatment with carvedilol alters the S(i) in patients with CHF during a prospective, double-blinded, placebo-controlled study.
Methods And Results:
The patients were randomized to receive either carvedilol (n=29) or matched placebo (n=17). Insulin and glucose responses were measured during a 0.3 g/kg intravenous glucose tolerance test, and S(i) was calculated according to Bergman's Minimal Model. Baseline S(i) values correlated significantly with body mass index (r=-0.42, P=0.002), plasma urate (r=-0.42, P=0.002), plasma HDL-cholesterol (r=0.39, P=0.003), maximal oxygen uptake (r=0.35, P=0.009), plasma triglycerides (r=-0.34, P=0.01) and weight (r=-0.29, P=0.03). During the study the insulin sensitivity was unchanged in the carvedilol group compared with placebo (2.63+/-1.45 to 2.38+/-1.64 vs. 2.81+/-2.36 to 2.48+/-1.84x10(-4) min(-1)/mUl(-1), P=0.83).
Conclusion:
Additional treatment with carvedilol is neutral with regard to influence the insulin sensitivity in patients with mild to moderate CHF.