Effect of selective and non-selective β -blockers on body weight, insulin resistance and leptin concentration in chronic heart failure

Background Chronic heart failure (CHF) is characterized by increased insulin resistance and hyperleptinaemia. We aimed to study effects of selective and non-selective β -blockers on body weight, insulin resistance, plasma concentrations of leptin and resistin in patients with CHF. Methods Twenty-six non-cachectic β -blocker-naive patients with CHF were randomized and treated with either carvedilol or bisoprolol. Body weight, plasma concentrations of leptin, resistin, fasting glucose and insulin were measured at baseline and after 6 months of therapy. Insulin resistance was estimated by homeostasis model assessment- estimated insulin resistance (HOMA-IR). Results Body weight increased significantly in the carvedilol group (mean change + 2.30 kg, p = 0.023) while it did not change in the bisoprolol group (mean change –0.30 kg, p = 0.623) (ns between groups). Plasma leptin concentration increased only in the carvedilol group (mean change + 4.20 ng/ml, p = 0.019) (ns between groups). Fasting glucose and resistin remained unchanged in both groups. After 6 months, mean plasma insulin concentration changed significantly differently (p = 0.015) in the bisoprolol (mean change +3.1 µU/ml) compared to the carvedilol group (mean change –6.3 µU/ml) and HOMA-IR was consequently higher in the bisoprolol compared to the carvedilol group (5.2 ± 4.2 vs 2.8 ± 1.6, p = 0.046). Conclusion This study found different metabolic effects of carvedilol and bisoprolol in non-cachectic patients with CHF. With unchanged fasting plasma glucose concentration after 6 months of treatment, carvedilol significantly decreased plasma insulin concentration and insulin resistance compared to bisoprolol.