Carvedilol, a newer member of the beta-blocker family of heart drugs, has saved more lives than an older drug, and has also cut the incidence of heart attacks and strokes, according to European researchers.
The five-year study of more than 3,000 people with heart failure, where the heart progressively loses its ability to pump blood, found a 21% lower incidence of heart attacks and a 25% lower incidence of fatal strokes among those who took carvedilol (brand name Coreg) compared with those taking an older medication, metoprolol (Lopressor).
"This is quite a different message from what they said before," Dr. Deepak Bhatt, associate director of the Cleveland Clinic's cardiovascular coordinating center, said.
"Earlier, they described reductions in deaths from heart failure," said Bhatt. "Now, they say Coreg) is good not only for the heart muscle but also for the arteries."
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 important tools 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," 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 are still 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.
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."