Mortality Reduction Associated With β-Adrenoceptor Inhibition in Chronic Heart Failure Is Greater in Patients With Diabetes.

Autor:	Witte KK; Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K., Drozd M; Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K., Walker AMN; Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K., Patel PA; Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K., Kearney JC; Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K. m.t.kearney@leeds.ac.uk., Chapman S; Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K., Sapsford RJ; Cardiology Department, Leeds Teaching Hospitals NHS Trust, Leeds, U.K., Gierula J; Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K., Paton MF; Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K., Lowry J; Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K., Kearney MT; Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K. m.t.kearney@leeds.ac.uk., Cubbon RM; Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, U.K.
Jazyk:	angličtina
Zdroj:	Diabetes care [Diabetes Care] 2018 Jan; Vol. 41 (1), pp. 136-142. Date of Electronic Publication: 2017 Oct 05.
DOI:	10.2337/dc17-1406
Abstrakt:	Objective: Diabetes increases mortality in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction. Studies have questioned the safety of β-adrenoceptor blockers (β-blockers) in some patients with diabetes and reduced left ventricular ejection fraction. We examined whether β-blockers and ACE inhibitors (ACEIs) are associated with differential effects on mortality in CHF patients with and without diabetes. Research Design and Methods: We conducted a prospective cohort study of 1,797 patients with CHF recruited between 2006 and 2014, with mean follow-up of 4 years. β-Blocker dose was expressed as the equivalent dose of bisoprolol (mg/day) and ACEI dose as the equivalent dose of ramipril (mg/day). Cox regression analysis was used to examine the interaction between diabetes and drug dose on all-cause mortality. Results: Patients with diabetes were prescribed larger doses of β-blockers and ACEIs than were patients without diabetes. Increasing β-blocker dose was associated with lower mortality in patients with diabetes (8.9% per mg/day; 95% CI 5-12.6) and without diabetes (3.5% per mg/day; 95% CI 0.7-6.3), although the effect was larger in people with diabetes (interaction P = 0.027). Increasing ACEI dose was associated with lower mortality in patients with diabetes (5.9% per mg/day; 95% CI 2.5-9.2) and without diabetes (5.1% per mg/day; 95% CI 2.6-7.6), with similar effect size in these groups (interaction P = 0.76). Conclusions: Increasing β-blocker dose is associated with a greater prognostic advantage in CHF patients with diabetes than in CHF patients without diabetes. (© 2017 by the American Diabetes Association.)
Databáze:	MEDLINE
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