Cardioprotective Potential of Carvedilol

Carvedilol is a multiple-action cardiovascular agent that is a nonselective β-adrenoceptor antagonist and a vasodilator, β-Adrenoceptor antagonists reduce myocardial work, secondary to reductions in heart rate and contractility, both in animals and in humans. For these reasons, carvedilol may improve survival of acutely ischemic myocardium. The additional vasodilating activity of carvedilol, further reducing myocardial work by decreasing afterload and ventricular wall tension, may provide additional salvage over that afforded by β-adrenoceptor blockade alone. The comparative ability of carvedilol and propranolol to reduce infarct size in experimental models of acute myocardial infarction in the rat, pig and dog has been investigated utilizing a variety of experimental techniques. In the pig, the calcium channel antagonist, diltiazem, was also included as a second comparator agent. Infarct size was examined on stained tissue sections using quantitative image analysis. In the rat, carvedilol (1 mg/kg) reduced infarct size by 47% (p < 0.01, n = 11), and in the pig, carvedilol, at doses of 0.3 and 1 mg/kg, reduced infarct size by 46% (p < 0.05, n = 6) and 89% (p < 0.001, n = 6), respectively. In dogs subjected to ischemia and reperfusion, carvedilol (1 mg/kg) reduced infarct size by 78% (p < 0.02, n = 6), and in dogs subjected to permanent left anterior descending coronary artery occlusion, carvedilol, at doses of 0.3 and 1 mg/kg, reduced infarct size by 46 and 63%, respectively (p < 0.02, n = 12-16). In all studies, the extent of myocardial survival on carvedilol exceeded that on propranolol. In the pig, the reduction in infarct size produced by carvedilol exceeded that provided by diltiazem. Taken together, these studies demonstrate the ability of carvedilol to protect ischemic myocardial tissue from necrosis.