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Efficacy, safety and tolerability of metoprolol CR/XL in patients with diabetes and chronic heart failure: Experiences from MERIT-HF
Abstract
Background The objective of the current study was to examine the efficacy and tolerability of the beta-blocker metoprolol succinate controlled release/extended release (CR/XL) in patients with diabetes in the Metoprolol CR/XL Randomized 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% CI 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 II (CIBIS II), 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% CI 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 data showed a statistically significant survival benefit in patients with diabetes.
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In the citing paper
“The coexistence of type 2 diabetes mellitus (T2DM) and heart failure (HF), either with reduced (HFrEF) or preserved ejection fraction (HFpEF), is frequent (30-40% of patients)”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [37]
In the citing paper
“The highest prevalence of T2DM was seen in trials of acute HF (around 40%).”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [37]
In the citing paper
“In clinical trials of chronic HF patients, the prevalence of T2DM was around 30%, irrespective of HF phenotype (i.e.HFrEF and HFpEF) (Table 3).31 -48”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [37]
In the citing paper
“Clinical trial results are somewhat conflicting regarding the risk of all-cause and CV mortality attributed to T2DM in HF patients, but most clinical trials reported an increased risk of death in patients with concurrent T2DM and HF (Table 5).1,31 -35,37,40,42,44,45,69,88-92”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [37]
In the citing paper
“Subgroup analyses of large HF trials show that beta-blockers reduce mortality and hospitalization and improve symptoms in moderate to severe HF, irrespectively of T2DM.37,152,153”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [37]
In the citing paper
“The MERIT-HF trial reported similar efficacy and safety of metoprolol succinate in patients with and ©2018 The Authors European Journal of Heart Failure ©2018 European Society of Cardiology without T2DM.37”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [37]
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Metadata
- Authors
- Deedwania, P. C., Giles, T. D., Klibaner, M., Ghali, J. K., Herlitz, J., Hildebrandt, P., Kjekshus, J., Spinar, J., Vitovec, J., Stanbrook, H., & Wikstrand, J.
- Affiliations
- Veterans Health Administration (US)
- Louisiana State University (US)
- AstraZeneca (United States) (US)
- Sahlgrenska University Hospital (SE)
- Oslo University Hospital (NO)
- Corresponding author
- Deedwania, Prakash C.
- Venue
- American Heart Journal
- Publisher
- Elsevier BV
- Published
- 2005-01
- Volume
- 149
- Issue
- 1
- Pages
- 159-167
- ISSN
- 0002-8703 (ISSN-L)
- OpenAlex
- W1980524591
- Cited by
- 143
- References
- 21
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 6 · 2023: 4 · 2022: 3 · 2021: 7 · 2020: 8 · 2019: 10 · 2018: 6 · 2017: 7 · 2016: 10 · 2015: 7 · 2014: 11 · 2013: 2 · 2012: 2
- FWCI
- 9.34
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Borås Academic Digital Archive (University of Borås) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- metoprolol succinate, beta-blockers, chronic heart failure, diabetes mellitus, heart failure hospitalization, survival benefit, drug tolerability, adverse events, Copernicus
- MeSH terms
- Adrenergic beta-Antagonists, Adult, Aged, Delayed-Action Preparations, Diabetes Mellitus, Double-Blind Method, Female, Heart Failure, Hospitalization, Humans, Male, Metoprolol, Middle Aged, Risk, Proportional Hazards Models, Survival Analysis, Diabetes Complications
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