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Published Online, 25 March 2008, www.theannals.com, DOI 10.1345/aph.1K447.
 The Annals of Pharmacotherapy: Vol. 42, No. 4, pp. 564-571. DOI 10.1345/aph.1K447
© 2008 Harvey Whitney Books Company.
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DRUG INFORMATION ROUNDS

Impact of Carvedilol on the Serum Lipid Profile

Randall P Sharp, PharmD

Associate Professor of Pharmacy Practice, College of Pharmacy, Southwestern Oklahoma State University, Weatherford, OK

Riaz Sirajuddin, MD

Cardiologist, Heart Solutions of Oklahoma, Oklahoma City, OK

Imran M Sharief, MD

Research Associate, Heart Solutions of Oklahoma

Reprints: Dr. Sharp, College of Pharmacy, Southwestern Oklahoma State University, 100 Campus Dr., Weatherford, OK 73096, fax 405/378-7628, randall.sharp{at}swosu.edu

OBJECTIVE: To examine the evidence regarding the impact of carvedilol on the serum lipid profile.

DATA SOURCES: Searches in MEDLINE and International Pharmaceutical Abstracts (1966-December 2007) were conducted. Search terms included carvedilol, cholesterol, lipids, hyperlipidemia, and β-blockers.

STUDY SELECTION AND DATA EXTRACTION: Published studies and case reports that evaluated the impact of carvedilol on the lipid profile were reviewed. One study was excluded because it evaluated carvedilol for an off-label use and was a small Phase 2 pilot study that evaluated the results of only 10 patients.

DATA SYNTHESIS: Twelve studies were available for review; 6 of these compared carvedilol with β1-selective antagonists. Three studies compared carvedilol with other antihypertensive medications; 2 of those studies evaluated total cholesterol only. Carvedilol alone was evaluated for its effects on lipids in 3 small single-group studies. In 4 of the 12 studies, carvedilol independently improved the lipid profile significantly, while the drug had a nonsignificant, neutral effect on the lipid profile in 3 studies. Furthermore, in 4 of the 12 studies, carvedilol was compared with other antihypertensive medications. In 3 of these 4 studies, the other drugs worsened the lipid profile significantly compared with carvedilol, while carvedilol significantly improved the lipid profile in the other study. Finally, carvedilol had a potentially negative effect on high-density lipoprotein cholesterol in a single-group study, but p values were not reported.

CONCLUSIONS: It is clear that β1-selective antagonists worsen the lipid profile compared with carvedilol. However, it is unclear whether carvedilol independently makes an improvement or has a neutral effect on the lipid profile. Carvedilol should be an important treatment consideration in patients with heart failure and/or hypertension with dyslipidemia. However, many questions remain regarding this issue.

Key Words: β-blockers, carvedilol, cholesterol, hyperlipidemia

Published Online, March 25, 2008. www.theannals.com, DOI 10.1345/aph.1K447




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