Efficacy and tolerability of the long-term administration of carvedilol in patients with chronic heart failure with and without concomitant diabetes mellitus

Background: Diabetes is frequently associated with heart failure and is an independent risk factor for an increased mortality and morbidity. Beta-blockers are traditionally regarded as relatively contraindicated in patients with diabetes mellitus. Aim of the study: To assess the efficacy and tolerability of carvedilol administration in patients with heart failure and concomitant diabetes. Methods and results: One hundred ninety-three patients (68 diabetics, 125 non-diabetics) with chronic heart failure were assessed by radionuclide ventriculography, cardiopulmonary exercise testing and right heart catheterization before and after 12 months of maintenance carvedilol treatment (mean dose, 40 +/- 19 mg daily). Diabetic patients were older and with a lower peak Vo(2) compared with non-diabetics. Long-term carvedilol administration was associated with an improvement in left ventricular function, clinical symptoms, resting and exercise hemodynamic parameters compared to baseline, with no significant difference between the diabetic and the non-diabetic patients. The incidence of adverse effects was also similar between the two groups. Diabetics had higher all-cause mortality with a similar mortality and hospitalization rate, compared to non-diabetics during 33 +/- 20 months of follow-up. Conclusion: Concomitant diabetes does not influence the efficacy and tolerability of carvedilol administration in patients with chronic heart failure. (C) 2003 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.