Optimizing treatment of diabetes and cardiovascular disease with combined α,β‐blockade

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. β‐Blockers are established to reduce cardiovascular risk in patients with hypertension, coronary heart disease, and heart failure. Despite this benefit of β‐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 β‐blockers on the treatment of cardiovascular disease in patients with diabetes.

Results: There is a large cardioprotective benefit with the use of β‐blockers in patients with diabetes; however, metabolic risks are associated with some β‐blockers. Newer, vasodilating, nonselective β‐blockers do not have the same adverse metabolic consequences observed with earlier β‐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 β‐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 β‐blockers.

Key words: :

• β‐Blockers
• Cardiovascular disease
• Carvedilol
• Diabetes