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Cardiovascular diseases remain the main cause of morbidity and mortality all over the world. As a result of significant developments in the field of prevention and improvement of treatment outcomes we are observing a steady decrease in mortality due to coronary artery disease (CAD) [1]. Largely we owe it to evidence-based medicine. Results of large, randomized clinical studies constitute the rationale for using drugs with proven efficacy that reduce the occurrence of hard end points, especially mortality. In Europe 20% of deaths are attributed to CAD [2]. According to recent studies, relative incidence of ST-segment elevation myocardial infarction (STEMI) is decreasing, while that of non-ST-segment elevation myocardial infarction increases (NSTEMI) [3, 4]. Arterial hypertension remains the most important risk factor for cardiovascular diseases, including CAD, that leads to numerous premature deaths. Prevalence of arterial hypertension is steadily rising – according to the results of NATPOL 2011 study it increased from 30% to 32% in a Polish population. At this rate, by 2035 this number will have increased by half [5]. It is also a wellknown fact that poor control of arterial hypertension correlates with cardiovascular risk in a linear fashion. CAD and arterial hypertension are the main etiological factors involved in development of heart failure, which affects 1-2% of adult population. In Poland, the number of patients living with heart failure is estimated at 800 000 and the number is growing. The main cause of increase in the frequency of occurrence of heart failure include ageing of the population and consequences of increasingly more effective treatment of acute conditions, e.g. acute coronary syndromes. Patients survive, but suffer from late complications, such as heart failure. The number of patients suffering from heart failure with preserved ejection fraction steadily increases, ranging from 22% to 73% [6], which is accompanied by a decreasing trend for heart failure with reduced ejection fraction. According to the results of Heart Failure Pilot Survey registry, which included 6108 patients (1159 from Poland), Polish patients are more frequently hospitalized due to acute heart failure, develop heart failure at younger age and are more severely ill, presenting with higher New York Heart Association (NYHA) class on hospital admission [7]. The cornerstone of treatment for CAD, arterial hypertension and heart failure are b-blockers, and among them a non-selective b and a1 receptor antagonist – carvedilol – plays an important role. Clinical potential and mechanism of action of carvedilol has been thoroughly discussed in our previous publication from 2003 [8]. However, due to the appearance of numerous new studies grounding the leading role of carvedilol among other b-blockers, we decided to prepare another article that would summarize and systematize current knowledge and highlight indications for the use of carvedilol in patients with cardiovascular disease.

Carvedilol – is it still the primus inter pares among b-blockers?