Updated meta-analysis of risk of cardiovascular mortality with rosiglitizone

January 01, 0001

Updated meta-analysis of risk of cardiovascular mortality with rosiglitizone

The objective of this study my US authors was to systematically review the effects of rosiglitazone therapy on myocardial infarction (MI) and mortality (cardiovascular {CV} and all-cause). They searched MEDLINE, the Web site of the Food and Drug Administration, and the GlaxoSmithKline clinical trials registry for trials published through February 2010. They included 56 all randomized controlled trials of rosiglitazone at least 24 weeks in duration that reported CV adverse events. The trials included 35,531 patients: 19,509 who received rosiglitazone and 16,022 who received control therapy.

They found: "Rosiglitazone therapy significantly increased the risk of MI (OR, 1.28) but not CV mortality (OR, 1.03). Exclusion of the RECORD (Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycemia in Diabetes) trial yielded similar results but with more elevated estimates of the OR for MI (OR, 1.39) and CV mortality (OR, 1.46; (NS). An alternative analysis pooling trials according to allocation ratios allowed inclusion of studies with no events, yielding similar results for MI (OR, 1.28) and CV mortality (OR 0.99)."

The authors concluded: "Eleven years after the introduction of rosiglitazone, the totality of randomized clinical trials continue to demonstrate increased risk for MI although not for CV or all-cause mortality. The current findings suggest an unfavorable benefit to risk ratio for rosiglitazone."

Since a main concern for diabetics is prevention of cardiovascular events, rosiglitizone is clearly not a good choice for therapy.

For the full abstract, click here.

Arch Intern Med 170(14):1191-1201, 26 July 2010 © 2010 to the American College of Physicians
Rosiglitazone Revisited-An Updated Meta-analysis of Risk for Myocardial Infarction and Cardiovascular Mortality. Steven E. Nissen, Kathy Wolski.

Category: K. Circulatory, T. Endocrine/Metabolic/Nutritional. Keywords: diabetes type II, rosiglitizone, myocardial infarction, MI, cardiovascular mortality, all-cause mortality, meta-analysis of randomized controlled trials, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 17 August 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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