A critical review of the use of carvedilol in ischemic heart disease.
β-Adrenergic receptor antagonists (β-blockers) have been recognized for their cardioprotective properties, prompting use of these pharmacologic agents to become more mainstream in acute myocardial infarction (AMI) and congestive heart failure (CHF). Despite their popularity as a class, the ability to protect the myocardium varies significantly between different agents. Carvedilol is a non-selective β-blocker with α₁-adrenergic receptor antagonism properties. It is unique among β-blockers because in addition to improving exercise tolerance and its anti-ischemic properties secondary to a reduction in heart rate and myocardial contractility, carvedilol exerts other beneficial effects including: antioxidant effects; reduction in neutrophil infiltration; apoptosis inhibition; reduction of vascular smooth muscle migration; and improvement of myocardial remodeling post-AMI. These properties, documented in animal models and subsequent clinical trials, are consistent with established evidence demonstrating decreased morbidity and mortality in patients with CHF and post-AMI. This article reviews the role of carvedilol compared with other β-blockers in the treatment of CHF and post-AMI management.
Center for Heart and Vessel Preclinical Studies, St John Hospital and Medical Center, Wayne State University School of Medicine, Detroit, MI 48236, USA.
Carol
C
Chen-Scarabelli
Louis
L
Saravolatz
Yahya
Y
Murad
Wen-Shi
WS
Shieh
Waqas
W
Qureshi
Justin
J
Di Rezze
Rodeo
R
Abrencillo
Tova
T
Gardin
Umesh K
UK
Gidwani
Louis
L
Saravolatz
Giuseppe
G
Faggian
Tiziano M
TM
Scarabelli
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D060050:Angina, Stable / Q000188:drug therapy; D000818:Animals; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000975:Antioxidants / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000188:drug therapy / Q000517:prevention & control; D002227:Carbazoles / Q000627:therapeutic use*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D000077261:Carvedilol; D019317:Evidence-Based Medicine; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy / Q000517:prevention & control; D017202:Myocardial Ischemia / Q000188:drug therapy*; D011412:Propanolamines / Q000627:therapeutic use*
D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D000975:Antioxidants; D002227:Carbazoles; D002316:Cardiotonic Agents; D011412:Propanolamines; D000077261:Carvedilol