ABSTRACT
The purpose of the study was to evaluate anti-ischemic and metabolic effects of the cardioselective beta-adrenoblockers nebivolol and retarded metoprolol-metaprolol CR/XL (betalok ZOK) in patients with postinfarction heart dysfunction, associated with type II diabetes mellitus (DM). 40 patients with coronary heart disease (CHD), functional class (FC) II-III exertional angina, postinfarction left ventricular (LV) dysfunction, and NYHA FC II heart failure, associated with type II DM, were randomized into 2 groups. The 20 patients of the 1st group were administered nebivolol in a dose of 1.25 to 5 mg per day, the 20 patients of the 2nd group - betalok ZOK in a dose of 12.5 to 100 mg per day. The course therapy lasted 8 weeks. The effects of the treatment were evaluated using paired veloergometry, echoCG, and lipid spectrum analysis. The study found that nebivolol in a mean dose of 4.2 +/- 0.3 mg per day and betalok ZOK in a dose of 46.5 +/- 6.2 mg per day reduced the frequency and severety of angina attacks (by 73.8% and 67.8%, respectively) and daily nitroglycerine uptake (by 78.6% and 69.1%, respectively), and increased activity tolerance (by 7.9% and 25.3%, respectively). None of the preparations displayed any adverse effects on carbohydrate exchange and blood lipid spectrum. Nebivolol, unlike betalok ZOK, significantly (p = 0.02) reduced triglyceride blood level by 29%. Thus, the new generation cardioselective beta1-adrenoblockers nebivolol and metoprolol CR/XL (betalok ZOK) provide anti-ischemic and metabolic effects in patients with CHD and postinfarction LV dysfunction, associated with type 2 diabetes mellitus. Nebivolol is preferable as far as blood lipid spectrum is concerned.
Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Benzopyrans/therapeutic use , Coronary Circulation/drug effects , Ethanolamines/therapeutic use , Lipids/blood , Metoprolol/analogs & derivatives , Metoprolol/therapeutic use , Myocardial Infarction/complications , Ventricular Dysfunction, Left/drug therapy , Adrenergic beta-Antagonists/administration & dosage , Benzopyrans/administration & dosage , Blood Glucose/metabolism , Coronary Angiography , Coronary Circulation/physiology , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/complications , Dose-Response Relationship, Drug , Echocardiography , Ethanolamines/administration & dosage , Exercise Test , Female , Follow-Up Studies , Heart Ventricles/diagnostic imaging , Heart Ventricles/physiopathology , Humans , Male , Metoprolol/administration & dosage , Middle Aged , Myocardial Infarction/blood , Myocardial Infarction/diagnostic imaging , Nebivolol , Treatment Outcome , Ventricular Dysfunction, Left/blood , Ventricular Dysfunction, Left/etiologyABSTRACT
Coronary artery stenting was carried out in 18 patients with angina recurrence 29.3+/-7.6 after coronary artery bypass grafting. Paired bicycle exercise tests, (199)Tl single photon emission tomography and graft angiography were used in evaluation of patients. Occlusions of 1 or 2 venous grafts were found in 38.9%, stenoses of both previously bypassed and native arteries in 27.8% of patients. Implantation of stents in grafts and/or native coronary arteries was associated with 2.7 fold decrease of angina frequency, 3 fold decrease of nitroglycerine consumption, 72.5% increase of exercise tolerance. The use of statins resulted in obvious lowering of total and low density lipoprotein cholesterol.
