BERLIN, Sept. 3 (UPI) -- Heart remodeling -- a dangerous structural change that occurs in patients with a condition known as heart failure -- can be slowed significantly in patients who receive the beta-blocker drug carvedilol, researchers reported Tuesday.
"The trial results clearly demonstrate that early addition of carvedilol to other therapies in mild heart failure can reverse the effects of remodeling, which will significantly improve the prognosis for patients," said Dr. Willem Remme, director of the Sticares Cardiovascular Research Foundation in Utrecht, the Netherlands, at the annual congress of the European Society of Cardiology.
About 4 million people in the United States suffer from heart failure, a diagnosis that is devastating, said Remme, because mortality from the disease is greater than that for most cancers. In heart failure, the normally oval-shaped left ventricle of the heart -- the major blood pumping chamber -- becomes rounder and larger, usually because of injury caused by a heart attack.
As the remodeling process continues, the heart cannot pump blood efficiently and patients often tire easily and frequently have difficulty breathing. The misshapen heart also can beat abnormally, creating rhythmic distubances which can be rapidly fatal.
In the Carvedilol ACE Inhibitor Remodeling Mild CHF Evaluation, or CARMEN, trial, patients who were diagnosed with mild heart failure were assigned to receive one of three drug regimens: carvedilol plus a placebo medication; the angiotensin-converting enzyme, or ACE, inhibitor, enalapril and a placebo; or both enalapril and carvedilol.
Remme noted that people with mild heart failure still may be able to lead a normal daily life, but if their condition is left untreated they can sustain further heart damage, leading to a rapid progression of the disease to a severe and debilitating condition.
Imaging studies determined that remodeling was slowed significantly by carvedilol alone, but not by enalapril. Nevertheless, Remme said, the combination of the two drugs worked best of all in protecting patients' hearts.
Standard therapy in treating mild heart failure is to start patients on ACE-inhibitors, said Dr. Abraham Caspi, professor of cardiology at the Hebrew University in Jerusalem, who applauded Remme "for his courage to challenge historical therapy."
Caspi told United Press International he would expect clinicians would not abandon starting patients on ACE-inhibitors, despite the findings by Remme and numerous other researchers showing the benefits of beta blockers in treating heart failure.
"However," he said, "I think doctors may begin treating patients with the combination."
The CARMEN study, supported by F. Hoffman-La Roche, of Basel, Switzerland, the manufacturer of carvedilol, enrolled 572 patients into the multicenter trial in 13 European countries.
Patients took their drugs for 18 months. Ultrasound devices were employed to measure left ventricular functioning of the heart non-invasively. All three of the treatment alternatives resulted in similar ability of patients to tolerate the medication. Side effects in each group also were similar.
"CARMEN is the first large-scale direct comparison of a beta-blocking agent versus an ACE-inhibitor on the effects of ongoing damage of the heart," Remme said. "It indicated that carvedilol can be safely administered before starting ACE-inhibitor treatment, but it is clear from these results that patients presenting with mild heart failure should receive a combination of carvedilol and an ACE-inhibitor at the initiation of therapy to help slow disease progression."
