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Carvedilol May Top Metoprolol for Preventing Major Vascular Events in Heart Failure Patients: Presented at ACC

By Jill Stein

NEW ORLEANS, LA -- March 11, 2004 -- Carvedilol appears to protect heart failure patients against major vascular events.

The data, presented here on March 9^th at the American College of Cardiology 53^rd Annual Scientific Session, are drawn from a sub-analysis of the Carvedilol or Metoprolol European Trial (COMET).

The COMET study, conducted in 317 European medical centers, showed that carvedilol treatment resulted in a significantly greater survival rate than metoprolol in 3,029 patients with New York Heart Association class II-IV heart failure (HF), with a 20% reduction for cardiovascular (CV) mortality (P = .0004). In the investigation, the target dose of carvedilol was 25 mg BID and the target dose of metoprolol was 50 mg BID.

In the sub-analysis, the researchers aimed to determine the differentiation of CV deaths and the possible contribution of carvedilol to the decrease in vascular events.

All subjects had chronic heart failure, a prior hospital admission for cardiovascular causes, an ejection fraction of 35% or less, and had been treated optimally with diuretics and angiotensin-converting -enzyme inhibitors unless they were not tolerated.

Results of the sub-analysis revealed that sudden death and death due to worsening heart failure were reduced in the carvedilol group compared to the metoprolol group (P = .02, and P = .07 respectively), reported William J. Remme, MD Cardiovascular Research Foundation, Rhoon-Rotterdam, the Netherlands.

Myocardial infarctions (MIs) were reported in 4.6% of carvedilol and 6.2% of metoprolol patients (P = .03). Of these, 30.4% of the MIs were fatal in the carvedilol group and 38.3% in the metoprolol group. Incidence of cardiovascular death or non-fatal myocardial infarction combined was reduced by 19% in carvedilol compared to metoprolol patients (P = .0007).

Stroke occurred in 4.3% of carvedilol and 5.3% of metoprolol patients. Stroke-related deaths were significantly reduced with carvedilol treatment, with 20% of strokes being fatal in the carvedilol group compared to 47.5% in the metoprolol group (P = .0006). The difference between the 2 groups was apparent after several months and was maintained over time.

Extrapolation from the survival curve suggested that carvedilol increased median survival by 1.4 years compared to metoprolol.

Changes in blood pressure from baseline, measured after 4 months of treatment, were comparable between carvedilol and metoprolol (P > .6) in patients who died from stroke. Combined incidence of stroke and MI was in 8.6% with carvedilol versus 11.1% with metoprolol (P = .02)

Overall, the COMET results offer additional evidence on the significant benefits of carvedilol over metoprolol for the treatment of chronic heart failure, said Professor Philip Poole-Wilson, chairman of the COMET steering committee.


[Study title: Carvedilol Better Protects Against Vascular Events Than Metoprolol in Heart Failure: Results From COMET. Abstract 835-2]

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