Optimizing treatment of diabetes and cardiovascular disease with combined alpha,beta-blockade.

BACKGROUND

Cardiovascular risk factors of the diabetic patient should be treated as aggressively as those of the nondiabetic patient who has had a myocardial infarction. beta-Blockers are established to reduce cardiovascular risk in patients with hypertension, coronary heart disease, and heart failure. Despite this benefit of beta-blockers, physicians have been reluctant to use them in patients with diabetes, in whom they are even more effective, because of the negative effects on carbohydrate and lipid metabolism.

OBJECTIVE

This paper reviews (based on a Medline literature search to December 2004) the relationship between diabetes and cardiovascular risk factors, describes the metabolic consequences of insulin resistance, and discusses the impact of different beta-blockers on the treatment of cardiovascular disease in patients with diabetes.

RESULTS

There is a large cardioprotective benefit with the use of beta-blockers in patients with diabetes; however, metabolic risks are associated with some beta-blockers. Newer, vasodilating, nonselective beta-blockers do not have the same adverse metabolic consequences observed with earlier beta-blockers. Recent evidence has shown that they have a neutral effect on metabolic parameters and lipid profile. They do not promote insulin resistance and can be used safely in heart failure patients with diabetes.

CONCLUSIONS

Nonselective vasodilating beta-blockers, such as carvedilol, may be used in patients with cardiovascular disease and diabetes without the same negative metabolic consequences seen with the use of earlier generation beta-blockers.