Efficacy, safety and tolerability of metoprolol CR/XL in patients with diabetes and chronic heart failure: Experiences from MERIT-HF

Background The objective of the current study was to examine the efficacy and tolerability of the p-blocker metoprolol succinate controlled release/extended release (CR/XL) in patients with diabetes in the Metoprolol.CR/XL Random-. ized Intervention Trial in Chronic Heart Failure (MERIT-HF). Methods The Cox proportional hazards model was used to calculate hazard ratios (HR) for convenience expressed as relative risks (risk reduction = 1-HR), and 95% confidence intervals (CI). Results The risk of hospitalization for heart failure was 76% higher in diabetics compared to non-diabetics (95% Cl 38% to 123%). Metoprolol CR/XL was well tolerated and reduced the risk of hospitalization for heart failure by 37% in the diabetic group (95% CI 53% to 15%), and by 35% in the non-diabetic group (95% CI 48% to 19%). Pooling of mortality data from the Cardiac Insufficiency Bisoprolol Study 11 (CIBIS 11), MERIT-HF, and the Carvedilol Prospective Randomized Cumulative Survival Study (COPERNICUS) showed similar survival benefits in patients with diabetes (25%; 95% CI 40% to 4%) and without diabetes (36%; 95% Cl 44% to 27%); test of diabetes by treatment interaction.was non-significant. Adverse events were reported more often on placebo than on metoprolol CR/XL. Conclusions Patients with heart failure and diabetes have a much higher risk of hospitalization than patients without diabetes. Regardless of diabetic status, a highly significant reduction in hospitalizations for heart failure was observed with metoprolol CR/XL therapy, which was very well tolerated also by patients with diabetes. Furthermore, the pooled I data showed a statistically significant survival benefit in patients with diabetes.