Metoprolol CR/XL Safe, Effective for Heart Failure in Diabetics

In patients with diabetes and heart failure, treatment with the beta-blocker metoprolol succinate CR/XL (controlled release/extended release) safely reduces the risk of hospitalization and mortality.

Concern over lack of efficacy and potential adverse effects have prevented many doctors from prescribing beta-blockers for patients with diabetes and heart failure, lead author Dr. Prakash C. Deedwania of the University of California at San Francisco School of Medicine and colleagues note.

As part of the Metoprolol CR/XL Randomized Intervention Trial in Chronic Heart Failure (MERIT-HF), 985 diabetics and 3006 nondiabetics were randomized to metoprolol or placebo. The subjects, ages 40 to 80, with NYHA class II to IV heart failure, were followed for an average of 1 year.

Active treatment reduced the risk of hospitalization for heart failure by 37% in the diabetic group (p = 0.0026) and by 35% in the nondiabetic group (p = 0.0002). For patients with severe heart failure, corresponding reductions were 53% and 44%.
In the diabetic group, all-cause mortality risk was lowered 18% in the metoprolol CR/XL group. For those with severe heart failure, there was a 29% risk reduction.

The authors point out that adverse events were reported more often in the placebo arms than in the metoprolol CR/XL arms of the study. Furthermore, "no difference in adverse events indicating impaired glycemic control was observed" between the two arms in the diabetic subgroup.

"The excellent tolerability profile of metoprolol CR/XL may be due to the careful up-titration procedure used, and to the high degree of beta-1-selectivity, even at higher doses, of this extended release formulation," Dr. Deedwania’s group suggests.
To ascertain survival benefit of beta-blockers, the authors also performed a meta-analysis of patients in the Cardiac Insufficiency Bisoprolol Study II (CIBIS II), the Carvedilol Prospective Randomized Cumulative Survival Study (COPERNICUS), and MERIT-HF.

Pooled data revealed that the relative risk for all-cause mortality in patients with diabetes was 0.76, and in those without diabetes, it was 0.64, reductions that the authors point out were statistically significant.

"It is time to remove existing barriers for the use of beta-blocker treatment in patients with heart failure and diabetes…which should improve their quality of life by decreasing hospitalizations for heart failure, and also increase survival," the team concludes.
Am Heart J 2005;149:159-167.

===============================

FACT:
Nearly two-thirds (65%) of U.S. adults have heard of prescription drug discount cards for seniors that cover drugs from many different companies, there is relatively low awareness of prescription drug programs that assist lower income adults with the costs of medication. Only one-third (32%) of all adults have heard of patient assistance programs offered by some pharmaceutical companies to subsidize the costs of medications for lower income patients. Even fewer adults (20%) are aware of Together Rx, a drug discount card for lower income people offered by a coalition of pharmaceutical companies
available at https://www.diabetesmeds.org