Meta-analysis of carvedilol versus beta 1 selective beta-blockers (atenolol, bisoprolol, metoprolol, and nebivolol)

Am J Cardiol. 2013 Mar 1;111(5):765-9. doi: 10.1016/j.amjcard.2012.11.031. Epub 2013 Jan 4.

Abstract

Because carvedilol is a unique vasodilating β blocker (BB) exerting antioxidant activity and pleiotropic effects, it was theorized that it may confer more potent beneficial effects on cardiovascular mortality and morbidity in acute myocardial infarction (AMI) and heart failure (HF) settings. A systematic review and meta-analysis was performed of randomized, controlled, direct-comparison trials that included adults receiving atenolol, bisoprolol, metoprolol, nebivolol, or carvedilol to evaluate the effects of carvedilol compared to other BBs on mortality, cardiovascular events, and hospital readmissions in the setting of AMI or systolic HF. Compared to β(1)-selective BBs used in HF (8 trials, n = 4,563), carvedilol significantly reduced all-cause mortality (risk ratio 0.85, 95% confidence interval 0.78 to 0.93, p = 0.0006). In 3 trials of patients with AMI (n = 644), carvedilol significantly reduced all-cause mortality by 45% (fixed-effects model: risk ratio 0.55, 95% confidence interval 0.32 to 0.94, p = 0.03, random-effects model: risk ratio 0.56, 95% confidence interval 0.26 to 1.12, p = 0.10), with no reduction in non-fatal MI (risk ratio 0.61, 95% confidence interval 0.31 to 1.22, p = 0.16). In conclusion, carvedilol, as compared against atenolol, bisoprolol, metoprolol and nebivolol in randomized direct comparison trials, significantly reduced all-cause mortality in systolic HF patients. Additionally, carvedilol significantly reduced all-cause mortality compared with β(1)-selective BBs in AMI patients using the fixed-effects model but not using the random-effects model.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adrenergic beta-1 Receptor Antagonists / therapeutic use*
  • Atenolol / therapeutic use
  • Benzopyrans / therapeutic use
  • Bisoprolol / therapeutic use
  • Carbazoles / therapeutic use*
  • Carvedilol
  • Ethanolamines / therapeutic use
  • Global Health
  • Humans
  • Metoprolol / therapeutic use
  • Myocardial Infarction / drug therapy*
  • Myocardial Infarction / mortality
  • Nebivolol
  • Platelet Aggregation Inhibitors
  • Propanolamines / therapeutic use*
  • Survival Rate / trends
  • Treatment Outcome

Substances

  • Adrenergic beta-1 Receptor Antagonists
  • Benzopyrans
  • Carbazoles
  • Ethanolamines
  • Platelet Aggregation Inhibitors
  • Propanolamines
  • Nebivolol
  • Carvedilol
  • Atenolol
  • Metoprolol
  • Bisoprolol