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Carvedilol shown to have unique characteristics among beta blockers
November 23, 2009CHAMPAIGN, Ill. - In a new study, researchers report that a class of heart medications called beta-blockers can have a helpful, or harmful, effect on the heart, depending on their molecular activity.
The study, which appears in the journal Circulation Research, found that beta-blockers that target both the alpha- and beta-receptors on the heart muscle offer the most benefit to cardiac patients, while those that target only the beta-receptors can actually undermine the structure and function of the heart.
Circulation Research is published by the American Heart Association.
Heart disease is the leading cause of death in the United States. Patients with heart disease usually have higher levels of catecholamines - hormones that activate the beta-adrenergic receptors to stimulate cardiac muscle contraction. In this process, the heart initially grows to become a more efficient pump. Unfortunately, the researchers found, this growth also predisposes the heart to eventual failure.
Traditionally, beta-blockers targeting the beta-adrenergic receptors have been utilized as a long-term therapy for heart failure.
Interestingly, blocking adrenergic receptors has been widely used clinically for nearly 50 years without a full understanding of the molecular consequences of these drugs, said co-author and graduate student David Cervantes. Kevin Xiang, a professor of molecular and integrative physiology at the University of Illinois led the study. The research team also included researcher Catherine Crosby.
A previous study in 2003 showed that the beta-blocker carvedilol produced a greater survival benefit than another drug, metoprolol tartrate. Carvedilol targets both the beta- and alpha-adrenergic receptors.
The new study unveiled an elegant intracellular signaling system in which beta-receptor activation modulates alpha-adrenergic signaling. It showed that blocking the beta-receptor alone promotes cardiac remodeling via growth of cardiac fibroblasts induced by alpha-adrenergic receptor signaling. The growth of fibroblasts in the heart further damages the integrity and function of the heart.
This observation suggests that the use of carvedilol in combination with inhibitors of angiotensin-converting enzyme (ACE inhibitors) may be of the greatest benefit to cardiac patients, and has significant clinical implications on which beta-blockers patients should take.
"I think this is really good stuff," Xiang says. "It's a surprise project. It's not what we initially intended looking into. But it's a very nice, elegant study and a very beautiful cellular mechanism. It definitely will help people along the way to understand how to further manipulate this system. Beta blockers are still the most commonly used drug for heart disease."
University of Illinois at Urbana-Champaign
Heart disease is the leading cause of death in the United States. Patients with heart disease usually have higher levels of catecholamines - hormones that activate the beta-adrenergic receptors to stimulate cardiac muscle contraction. In this process, the heart initially grows to become a more efficient pump. Unfortunately, the researchers found, this growth also predisposes the heart to eventual failure.
Traditionally, beta-blockers targeting the beta-adrenergic receptors have been utilized as a long-term therapy for heart failure.
Interestingly, blocking adrenergic receptors has been widely used clinically for nearly 50 years without a full understanding of the molecular consequences of these drugs, said co-author and graduate student David Cervantes. Kevin Xiang, a professor of molecular and integrative physiology at the University of Illinois led the study. The research team also included researcher Catherine Crosby.
A previous study in 2003 showed that the beta-blocker carvedilol produced a greater survival benefit than another drug, metoprolol tartrate. Carvedilol targets both the beta- and alpha-adrenergic receptors.
The new study unveiled an elegant intracellular signaling system in which beta-receptor activation modulates alpha-adrenergic signaling. It showed that blocking the beta-receptor alone promotes cardiac remodeling via growth of cardiac fibroblasts induced by alpha-adrenergic receptor signaling. The growth of fibroblasts in the heart further damages the integrity and function of the heart.
This observation suggests that the use of carvedilol in combination with inhibitors of angiotensin-converting enzyme (ACE inhibitors) may be of the greatest benefit to cardiac patients, and has significant clinical implications on which beta-blockers patients should take.
"I think this is really good stuff," Xiang says. "It's a surprise project. It's not what we initially intended looking into. But it's a very nice, elegant study and a very beautiful cellular mechanism. It definitely will help people along the way to understand how to further manipulate this system. Beta blockers are still the most commonly used drug for heart disease."
University of Illinois at Urbana-Champaign
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Disparity in use of implantable devices to prevent sudden death in heart failure patients
A study of heart failure patients who meet national guidelines for devices that stabilize and strengthen the heart's electrical system found that only half of eligible patients received the devices.
Pre-hospital organization: The first links in the chain of survival for heart attack patients
Mortality rate following a heart attack has fallen by more than 50% in Europe over the past 25 years. However, because only minor advances in the medical treatment of AMI are expected over the next decade, it is through organisational changes in the pre-hospital phase that mortality rate will continue this decline to below 5%.
Beta-blockers and stroke -- new insights into their use for older people
A University of Leicester-led study may have uncovered the reason why Beta-blockers are less effective at preventing stroke in older people with high blood pressure, when compared to other drugs for high blood pressure.
Older drivers unaware of risks from medications and driving
Most older drivers are unaware of the potential impact on driving performance associated with taking medications, according to new research from the Center for Injury Sciences at the University of Alabama at Birmingham (UAB).
Study reveals mounting evidence of fish oil's heart health benefits
There is mounting evidence that omega-3 fatty acids from fish or fish oil supplements not only help prevent cardiovascular diseases in healthy individuals, but also reduce the incidence of cardiac events and mortality in patients with existing heart disease.
Atrial fibrillation linked to increased hospitalization in heart failure patients
Patients with atrial fibrillation, common in those with advanced chronic heart failure, have an increased risk of hospitalization due to heart failure.
Blood-pressure-lowering drugs should not be limited to people with high blood pressure
Blood pressure lowering drugs should be offered to anyone old enough to be at risk of a heart attack or stroke (or who is otherwise known to be at risk), regardless of their blood pressure.
Irregular heart rhythm before or after cardiac catheterization linked to risk of death
Certain heart attack patients who experience a rapid, abnormal heart rhythm before or after a coronary artery intervention or stent placement have a significantly higher risk of death within 90 days of the procedure.
Sleep apnea may not be closely linked to heart failure severity
Obstructive sleep apnea (OSA) and central sleep apnea (CSA) are not markedly decreased in heart failure (HF) patients managed with beta-blockers and spironolactone.
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