Subramanian Usha, Kamalesh Masoor, Temkit M'hamed, Eckert George J, Sawada Stephen
Krannert Institute of Cardiology and Roudebush Veterans Affairs Medical Center, Indiana University Medical Center, Indianapolis, Indiana 46202, USA.
Am J Cardiovasc Drugs. 2009;9(4):231-40. doi: 10.2165/1006180-000000000-00000.
The relative benefits of cardioselective beta-adrenoceptor antagonists (CSB) among patients with congestive heart failure (CHF) and diabetes mellitus are not firmly established.
To determine whether diabetic patients with CHF accrue the same mortality benefit from CSB therapy as non-diabetic patients.
Between October 1999 and November 2000 consecutive patients with CHF at the Veteran's Affairs Medical Center in Indianapolis, IN, USA, were enrolled in a randomized controlled trial and prospectively followed for 5 years. Disease severity and CHF-specific functional status were obtained from patients at baseline. Medical records were accessed for data regarding co-morbidities, medications, and mortality. Propensity-score analysis was used to balance co-variates because of the observational nature of CSB use, given this was a post hoc analysis. A multivariate Cox proportional hazards model was used to compare survival between diabetic and non-diabetic patients stratified by whether they were or were not receiving CSB therapy.
Of the 412 evaluable patients, 222 (54%) had diabetes and 212 (51%) were taking a CSB. At 5-year follow-up, 186 (45%) patients had died. In the multivariate analysis, using propensity scores to balance co-variates, CSB therapy was an independent predictor of survival in patients without diabetes (hazard ratio 0.60; p = 0.054) only.
These results extend prior observations that patients with diabetes and CHF may not accrue the same mortality benefit from CSB therapy as patients without diabetes, and warrant further prospective investigation.
在充血性心力衰竭（CHF）合并糖尿病患者中，心脏选择性β-肾上腺素能受体拮抗剂（CSB）的相对益处尚未明确确立。
确定CHF合并糖尿病患者从CSB治疗中获得的死亡率益处是否与非糖尿病患者相同。
1999年10月至2000年11月期间，美国印第安纳州印第安纳波利斯退伍军人事务医疗中心的CHF连续患者被纳入一项随机对照试验，并进行了5年的前瞻性随访。在基线时从患者处获取疾病严重程度和CHF特异性功能状态。查阅医疗记录以获取有关合并症、药物治疗和死亡率的数据。由于CSB使用的观察性质，采用倾向评分分析来平衡协变量，因为这是一项事后分析。使用多变量Cox比例风险模型比较接受和未接受CSB治疗分层的糖尿病和非糖尿病患者之间的生存率。
在412例可评估患者中，222例（54%）患有糖尿病，212例（51%）正在服用CSB。在5年随访时，186例（45%）患者死亡。在多变量分析中，使用倾向评分来平衡协变量，CSB治疗仅是无糖尿病患者生存的独立预测因素（风险比0.60；p = 0.054）。
这些结果扩展了先前的观察结果，即CHF合并糖尿病患者从CSB治疗中获得的死亡率益处可能与非糖尿病患者不同，值得进一步进行前瞻性研究。
