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Comment & Response
April 2015

β-Blockers in Diabetic Patients With Heart Failure

Author Affiliations
  • 1Columbia University Medical Center, New York, New York
JAMA Intern Med. 2015;175(4):657. doi:10.1001/jamainternmed.2014.8009

To the Editor Pasternak et al1 report that the effectiveness of metoprolol succinate and carvedilol in patients with heart failure is similar. Counteracting neurohormonal hyperactivation through β-blockers represents an established cornerstone for the treatment of heart failure. However, owing to their glycometabolic effects there are some issues concerning the use of β-blockers in patients with diabetes mellitus, which account for approximately one-third of patients with heart failure.2,3 The large and accurate population study by Pasternak et al1 could be very helpful in unveiling potentially diverse outcomes in diabetic patients receiving a selective β1-adrenergic receptor blocker (metoprolol succinate) vs a nonselective β121–blocker (carvedilol), providing meaningful clinical and pathophysiological insights. Indeed, the different adrenergic receptors play a key role in the regulation of glucose homeostasis and insulin release.3,4 Unfortunately, the authors did not report any analysis on the group of diabetic patients, albeit clearly indicating the presence of patients receiving insulin or oral hypoglycemics.1

Similarly, given the importance of β-adrenergic receptors in the regulation of vascular tone,3,5 an evaluation in hypertensive patients could be interesting to readers.

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Article Information

Corresponding Author: Gaetano Santulli, MD, PhD, Columbia University Medical Center, New York, NY 10032 (gs2620@cumc.columbia.edu; gsantulli001@gmail.com).

Conflict of Interest Disclosures: None reported.

Pasternak  B, Svanström  H, Melbye  M, Hviid  A.  Association of treatment with carvedilol vs metoprolol succinate and mortality in patients with heart failure.  JAMA Intern Med. 2014;174(10):1597-1604.PubMedGoogle ScholarCrossref
Arnold  SV, Spertus  JA, Lipska  KJ,  et al.  Type of β-blocker use among patients with versus without diabetes after myocardial infarction.  Am Heart J. 2014;168(3):273-279.e1.PubMedGoogle ScholarCrossref
Kveiborg  B, Hermann  TS, Major-Pedersen  A,  et al.  Metoprolol compared to carvedilol deteriorates insulin-stimulated endothelial function in patients with type 2 diabetes—a randomized study.  Cardiovasc Diabetol. 2010;9:21.PubMedGoogle ScholarCrossref
Santulli  G, Lombardi  A, Sorriento  D,  et al.  Age-related impairment in insulin release: the essential role of β(2)-adrenergic receptor.  Diabetes. 2012;61(3):692-701.PubMedGoogle ScholarCrossref
Ciccarelli  M, Cipolletta  E, Santulli  G,  et al.  Endothelial beta2 adrenergic signaling to AKT: role of Gi and SRC.  Cell Signal. 2007;19(9):1949-1955.PubMedGoogle ScholarCrossref