Stable Angina Pectoris
Conditions
Keywords
Beta-blockers, Anti-anginal effect, Lipid metabolism, Glucose metabolism
Brief summary
There are few data regarding anti-anginal effects between beta-blockers with and without vasodilating property. Beta-blocker without vasodilating property is generally known to have unfavorable effects on glucose and lipid metabolism. Therefore, the investigators compared carvedilol and atenolol on anti-anginal and metabolic effects in patient with stable angina pectoris.
Detailed description
Previous studies have demonstrated that beta-blockers are effective in reducing not only ischemia but also cardiovascular mortality following myocardial infarction. And, recent guidelines have suggested the potential for use of beta-blockers as first-line agents in chronic stable angina. However, beta-blockers are a diverse class with different mechanisms of action and physiological effects. Various pharmacologic properties that characterize beta-blockers include cardioselectivity, intrinsic sympathomimetic activity, and concomitant vasodilating alpha-adrenoceptor blockade, which might exhibit differential anti-anginal efficacies. In addition, traditional beta-blockers, particularly nonvasodilating beta-blockers, have been reported to have negative metabolic effects, including hyperglycemia, insulin resistance, and dyslipidemia. These unfavorable effects of beta-blockers should be considered in patients with stable angina pectoris, because the pathophysiology of coronary artery disease is associated with abnormalities in glucose and lipid metabolism. Carvedilol, a newer vasodilating beta-blocker, has been shown to differ from traditional beta-blockers in terms of metabolic effects in patients with hypertension and diabetes. However, few data regarding comparative anti-anginal and metabolic effects between beta-blockers with and without vasodilating property have been reported, particularly in patients with angina pectoris. In this study, we simultaneously compared anti-anginal and metabolic effects of carvedilol and atenolol in patients with stable angina pectoris.
Interventions
DRUGCarvedilol
DRUGAtenolol
Sponsors
Gachon University Gil Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
20 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Stable angina pectoris who had a positive exercise treadmill test according to the American College of Cardiology Foundation and the American Heart Association guidelines
Exclusion criteria
* Acute coronary syndrome * Coronary revascularization within the past 3 months * Asthma or chronic obstructive lung disease * Bradycardia (heart rate \< 55 beat/min) * History of severe adverse reaction to beta-blockers * Symptomatic arrhythmia requiring anti-arrhythmia therapy * Heart failure * Severe renal or hepatic failure
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to 1-mm ST-segment depression | After 25 weeks of treatment | Time to 1-mm ST-segment depression at exercise treadmill test |
| Time to onset of angina | After 25 weeks of treatment | Time to onset of angina at exercise treadmill test |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Lipid profiles | After 25 weeks of treatment | Lipid profiles: total cholesterol, triglyceride, high-density lipoprotein-cholesterol, and low-density lipoprotein-cholesterol |
| Glucose metabolism | After 25 weeks of treatment | Fasting glucose, insulin, HbA1c, Quantitative Insulin-Sensitivity Check Index (QUICKI) |
| Blood pressure at resting and peak exercise | After 25 weeks of treatment | Blood pressure at resting and peak exercise during exercise treadmill test |
| Treatment-emergent adverse events | After 25 weeks of treatment | — |
| Seattle Angina Questionnaire (SAQ) scores | After 25 weeks of treatment | — |
| Heart rate at resting and peak exercise | After 25 weeks of treatment | Heart rate at resting and peak exercise during exercise treadmill test |
Countries
South Korea
Outcome results
None listed