Impact of carvedilol on the serum lipid profile.

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 beta-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 beta(1)-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 beta(1)-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.