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TZDs did not increase risk for cardiovascular death
Rosiglitazone, pioglitazone increased risk for congestive heart failure, but not for cardiovascular death.
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Patients with prediabetes or type 2 diabetes were at higher risk for developing congestive heart failure when assigned rosiglitazone or pioglitazone; however, the risk for cardiovascular death did not increase, according to a new meta-analysis.
“The absence of a signal for cardiovascular death raises the question of whether or not thiazolidinediones, and specifically rosiglitazone, carry an excess risk for ischemic heart disease mortality,” Richard W. Nesto, MD, of the Lahey Clinic Medical Centre in Burlington, Mass., told Endocrine Today.
Nesto and colleagues performed a meta-analysis of seven, randomized, double blind controlled trials that examined the association between congestive heart failure and TZDs with pre-diabetes or type 2 diabetes.
“We specifically looked at heart failure because we were interested in the risk for heart failure when exposed to either [rosiglitazone or pioglitazone] across a wide background of patients, such as those with prediabetes or long standing diabetes, to see if risk was different in those groups,” he said.
The researchers found that the “relative risk for heart failure was about the same, regardless of the history of cardiovascular disease.
“Despite the increase in relative risk, the absolute risk was actually quite low in some patients with diabetes, which should help clinicians determine which patients should be prescribed TZDs,” the researchers said in a press release.
“Our data indicate that these drugs should not be used in patients with heart failure and should be cautiously used for glycemic control in patients with cardiovascular disease who do not have heart failure,” they said. “In patients with type 2 diabetes without cardiovascular disease in whom the absolute risk for congestive heart failure is much lower, the use of TZDs should be weighed against the risks and benefits of other antidiabetic medications.”
The researchers added that they needed longer follow-up and better characterization of patients in whom congestive heart failure develops because of fluid retention to determine the effect of TZDs on overall cardiovascular outcome and whether congestive heart failure should be regarded as an adverse event or a characteristic cardiovascular endpoint. – by Christen Haigh
For more information:
- Lago RM, Singh PP, Nesto RW. Congestive heart failure and cardiovascular death in patients with prediabetes and type 2 diabetes given thiazolidinediones: a meta-analysis of randomized clinical trials. The Lancet. 2007;370:1129-1136.