ReviewMeta-Analysis of Carvedilol Versus Beta 1 Selective Beta-Blockers (Atenolol, Bisoprolol, Metoprolol, and Nebivolol)
Section snippets
Methods
A systematic review of the available published research according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for the conduct of systematic reviews of intervention studies was performed.4 Studies were identified through searches of the following sources: Ovid MEDLINE (1977 to 2012), PubMed (1978 to 2011), and Embase (1977 to 2012). To identify further potentially relevant studies missed by the electronic database search, reference lists from identified
Results
The search of the published research yielded 1,105 titles, of which 40 were reviewed in full text on the basis of the inclusion criteria (Figure 1). Of these, 11 studies were deemed eligible for inclusion (Figure 1).3, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17 Tables containing the characteristics of the included studies are available by request.
All trials were randomized direct comparison trials against carvedilol in patients with either HF or AMI. All background medications and baseline
Discussion
In this systematic review of 11 randomized controlled trials in 5,207 patients, we found that carvedilol significantly reduced all-cause mortality in patients with HF. Additionally, in patients with AMI, carvedilol significantly reduced all-cause mortality by fixed-effects model (but not by random-effects model) but did not reduce nonfatal MI compared to other commonly prescribed BBs, although carvedilol did demonstrate trends for reducing this end point. The preferential reduction in mortality
Disclosures
Dr. Lavie has served as a consultant and speaker for GlaxoSmithKline, London, United Kingdom (but not regarding β blockers). Dr. O'Keefe is a speaker for GlaxoSmithKline and Forest Pharmaceuticals, St. Louis, Missouri.
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