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Pioglitazone reduces major adverse CV events in prediabetes, diabetes
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In people with insulin resistance, prediabetes or diabetes, pioglitazone is associated with a decreased risk for major adverse cardiovascular events, study data show.
However, pioglitazone may increase risks for heart failure, bone fracture, edema and weight gain, according to the researchers.
Meng Lee, MD, of the department of neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital in Taiwan, and colleagues conducted a systematic review and meta-analysis on nine randomized controlled trials from 1966 to May 2016 to determine the effects of pioglitazone in people with insulin resistance, prediabetes and type 2 diabetes.
Pioglitazone was associated with lower risks for major adverse CV events (two trials; RR = 0.77; 95% CI, 0.64-0.93) and myocardial infarction (two trials; RR = 0.68; 95% CI, 0.49-0.96) and a trend toward reducing the risk for recurrent stroke (two trials; RR = 0.81; 95% CI, 0.65-1.01) among trial participants with prediabetes or insulin resistance.
There was an association between a lower risk for major adverse CV events and pioglitazone in trial participants with diabetes (five trials; RR = 0.83; 95% CI, 0.72-0.97). There was no significant difference between trial participants with diabetes treated with pioglitazone and comparator groups for risks for MI and stroke.
When compared with a control group, pioglitazone was tied to an increased risk for heart failure (five trials; RR = 1.32; 95% CI, 1.14-1.54) and bone fracture (four trials; RR = 1.52; 95% CI, 1.17-1.99), whereas no difference was observed in rates for all-cause mortality, any future cancer or bladder cancer risks. However, risks for edema (seven trials; RR = 1.63; 95% CI, 1.52-1.75), weight gain (four trials; RR = 1.6; 95% CI, 1.5-1.72) and hypoglycemia (five trials; RR = 1.24; 95% CI, 1.13-1.35) were higher among participants treated with pioglitazone compared with control groups.
Among people with prediabetes or insulin resistance, progression to diabetes was lower in groups treated with pioglitazone compared with those treated with placebo (two trials; RR = 0.4; 95% CI, 0.25-0.65).
“The current meta-analysis of completed, randomized clinical trials indicates that pioglitazone has beneficial effects in reducing the risk of [major adverse CV events] in people with insulin resistance, prediabetes and type 2 diabetes,” the researchers wrote. “Rates of heart failure, bone fracture, weight gain and edema increased in pioglitazone-treated patients, while the occurrences of cancer and all-cause mortality did not rise. Weighing the risk–benefit profile, treatment with pioglitazone may be a reasonable choice in appropriately selected patients with insulin resistance, prediabetes and type 2 diabetes.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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