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Cited by 36Heart Failure Treatment and ManagementHeart rate and cardiovascular healthCardiovascular Function and Risk Factors

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

Witte, Klaus K., Drozd, Michael, Walker, Andrew M.N., Patel, Peysh A., Kearney, Jessica C., Chapman, Sally, Sapsford, Robert J., Gierula, John +4 more·2018·Diabetes Care
DOI 10.2337/dc17-1406
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Abstract

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.

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  • Over 50% of NYHA Class II patients do not improve.

    “over 50% of those in New York Heart Association (NYHA) Class II patients do not improve.”

    From Prioritizing symptom management in the treatment of chronic heart failure (2020) · cites this paper as [8]

  • In 400 CHF patients with serial assessments from the authors' own published data, a significant portion continues to have symptoms despite optimal therapy.

    “as evidenced in 400 CHF patients with serial assessments from our own published data (Figure 1 ) 8 in which a significant portion continues to have symptoms despite optimal therapy”

    From Prioritizing symptom management in the treatment of chronic heart failure (2020) · cites this paper as [8]

  • β-Blocker therapy is known to foster numerous clinical benefits in some subjects with CVD, including reduced risks of heart attack, stroke, heart failure and death.

    “β-Blocker therapy is known to foster numerous clinical benefits in some subjects with CVD (e.g. reduced risks of heart attack, stroke, heart failure and death (Black et al., 2010; Burnett et al., 2017; Witte et al., 2018)).”

    From A Cardiovascular Disease-Linked Gut Microbial Metabolite Acts via Adrenergic Receptors (2020) · cites this paper as Witte et al., 2018

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Authors
Witte, K. K., Drozd, M., Walker, A. M. N., Patel, P. A., Kearney, J. C., Chapman, S., Sapsford, R. J., Gierula, J., Paton, M. F., Lowry, J., Kearney, M. T., & Cubbon, R. M.
Affiliations
  • University of Leeds (GB)
  • Leeds Teaching Hospitals NHS Trust (GB)
Corresponding author
Kearney, Jessica C.
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2017-10-05
Volume
41
Issue
1
Pages
136-142
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc17-1406
OpenAlex
W2762806134
Cited by
36
References
25
Citations by year
2024: 4 · 2023: 2 · 2022: 5 · 2021: 6 · 2020: 10 · 2019: 3 · 2018: 5 · 2017: 1
FWCI
4.02
Type
journal article
Language
en
Open access
closed
Licence
www.diabetesjournals.org/content/license (vor, 76 d)
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
Funders
British Heart Foundation (PG/08/020/24617)
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
chronic heart failure, diabetes mellitus, beta-blockers, ACE inhibitors, mortality, drug dosing, reduced left ventricular ejection fraction, bisoprolol, ramipril, drug interactions
MeSH terms
Adrenergic beta-Antagonists, Aged, Angiotensin-Converting Enzyme Inhibitors, Chronic Disease, Diabetes Mellitus, Dose-Response Relationship, Drug, Female, Follow-Up Studies, Heart Failure, Humans, Male, Prognosis, Prospective Studies, Biomarkers, Ventricular Function, Left

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