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Ser49Gly of beta1-adrenergic receptor is associated with effective beta-blocker dose in dilated cardiomyopathy.

Artikel i vetenskaplig tidskrift
Författare Yvonne Magnusson
Malin Levin
Robert Eggertsen
Ernst Nyström
Reza Mobini
Maria Schaufelberger
Bert Andersson
Publicerad i Clinical pharmacology and therapeutics
Volym 78
Nummer/häfte 3
Sidor 221-31
ISSN 0009-9236
Publiceringsår 2005
Publicerad vid Wallenberglaboratoriet
Hjärt-kärlinstitutionen
Institutionen för samhällsmedicin, Avdelningen för allmänmedicin
Institutionen för invärtesmedicin, Avdelningen för internmedicin
Sidor 221-31
Språk en
Länkar dx.doi.org/10.1016/j.clpt.2005.06.0...
Ämnesord Adrenergic beta-Antagonists, administration & dosage, therapeutic use, Aged, Amino Acid Substitution, Cardiomyopathy, Dilated, drug therapy, genetics, mortality, Codon, Cohort Studies, DNA, genetics, Dose-Response Relationship, Drug, Female, Genotype, Glycine, Humans, Male, Middle Aged, Polymorphism, Genetic, Prospective Studies, Receptors, Adrenergic, beta-1, drug effects, genetics, Serine, Survival Rate, Treatment Outcome
Ämneskategorier Medicin och Hälsovetenskap

Sammanfattning

OBJECTIVE: Our objective was to evaluate the influence of polymorphisms at codons 49 and 389 of the beta1-adrenergic receptor (beta1-AR) on the response to beta-blockers and outcome in patients with dilated cardiomyopathy. METHODS: We genotyped both codons of the beta1-AR in 375 patients with dilated cardiomyopathy and 492 control subjects. RESULTS: Neither of the polymorphisms was associated with susceptibility for dilated cardiomyopathy. In a retrospective analysis of patients receiving beta-blockers, there was a significant association between long-term survival rate and codon 49 (P = .014) but not codon 389 (P = .08). Despite a similar mean heart rate (69 beats/min), patients with the Ser49 genotype tended to have higher doses of beta-blockade compared with Gly49 carriers (P = .065). In patients receiving a low dose of beta-blockade (< or = 50% of targeted full dose), the 5-year mortality rate was lower among Gly49 carriers than Ser49 patients (risk ratio [RR], 0.24; 95% confidence interval [CI], 0.07-0.80; P = .020). In patients receiving high doses of beta-blockers, there was no significant difference in outcome between genotypes (P = .20), which was attributable to a better outcome for Ser49 patients treated with a high dose of beta-blockade as compared with a low dose. Gly49 carriers had a similar survival rate with different doses of beta-blockers. With low-dose beta-blockers, both codon 49 (RR, 0.26; 95% CI, 0.08-0.89; P = .029) and codon 389 (RR, 2.42; 95% CI, 1.04-5.63, P = .039) were related to 5-year mortality rate. CONCLUSION: In patients with heart failure, the influence of codon 49 on the outcome and effect of beta-blockers appeared to be more pronounced than that of codon 389. The more common Ser49Ser genotype responded less beneficially to beta-blockade and would motivate genotyping to promote higher doses for the best outcome effect.

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