New Beta Blocker Drug Reduces Heart Risks

Carvedilol, a newer member of the beta blocker family of heart drugs, saved more lives of patients with heart failure than an older drug and also cut the incidence of heart attacks and other events, European researchers report.

The five-year study of more than 3,000 people with heart failure -- in which the heart progressively loses its ability to pump blood -- found a 21 percent lower incidence of heart attacks and a 25 percent lower incidence of fatal strokes among those who took carvedilol (brand named Coreg) compared to those taking an older medication, metoprolol (Lopressor).

The study findings were somewhat of a surprise, said Dr. Deepak Bhatt, associate director of the Cleveland Clinic's cardiovascular coordinating center. He was not involved in the trial.

"This is quite a different message from what they said before," Bhatt said. "If you believe what is written here, you have an entirely different benefit of one type of beta blocker rather than another type. Earlier, they described reductions in deaths from heart failure. Now, they say [Coreg] is also a better drug for vascular-related endpoints -- that it is good not only for the heart muscle but also for the arteries."

The study -- which was funded by F. Hoffmann-La Roche and GlaxoSmithKline, the two companies that together market Coreg -- is published online by the Journal of the American College of Cardiology.

The new finding is the latest chapter in the history of beta blockers, which have been in and out of favor for treatment of high blood pressure and heart failure, said Dr. Stephen A. Siegel, assistant clinical professor of medicine at New York University.

"This helps clearly bring into line that beta blockers can be an important tool in the right patient population, especially those with congestive heart failure," Siegel said.

But the results also indicate that all beta blockers might not be created equal, he said.

The study results "indicate that carvedilol might be different from other beta blockers, that you do not have a 'class effect,' " Siegel said. "With the congestive heart failure data, carvedilol had better results than most of the other beta blockers. Some particular differences in terms of beta blocking effect might be part of why it is particularly beneficial in treatment of congestive heart failure."

But the results of the European trial still are somewhat controversial, and the choice of a beta blocker for individual patients might not be clear-cut, Bhatt said. The controversy arises from the dosages used in the European study, he said.

"The target dose of carvedilol was 25 milligrams twice a day," Bhatt said. "For the other drug, it was 50 milligrams twice a day, which is not the optimal dosage. One criticism that is not allayed by this report is that they used a better dosage of one drug than of the other drug."

When Bhatt prescribes metoprolol, "I shoot for more than 50 milligrams twice a day," he said. And he does prescribe metoprolol rather than carvedilol for some patients. "In general, I don't switch if they are tolerating it well," he said.

Cost is another element in the decision, Bhatt said. Coreg is much more expensive than metoprolol, which is now available in generic form.

"I don't think the data are strong enough to switch all patients to carvedilol," Bhatt said. "But there surely is no harm in the switch."