What is the cardiovascular risk of rosiglitazone in diabetics?

January 01, 0001

What is the cardiovascular risk of rosiglitazone in diabetics?

There has been significant controversy regarding the cardiovascular risk of rosiglitazone, a diabetic medication. These UK and US researchers compared the thiazolidinediones rosiglitazone and pioglitazone regarding their effects on myocardial infarction, congestive heart failure, and mortality diabetic patients. They performed a systematic review and meta-analysis of observational studies using Medline and Embase.

The researchers found: "Cardiovascular outcomes from 16 observational studies (4 case-control studies and 12 retrospective cohort studies), including 810?000 thiazolidinedione users, were evaluated after a detailed review of 189 citations. Compared with pioglitazone, use of rosiglitazone was associated with a statistically significant increase in the odds of myocardial infarction (n=15 studies, odds ratio 1.16), congestive heart failure (n=8, 1.22), and death (n=8, 1.14). Numbers needed to treat to harm (NNH), depending on the population at risk, suggest 170 excess myocardial infarctions, 649 excess cases of heart failure, and 431 excess deaths for every 100?000 patients who receive rosiglitazone rather than pioglitazone."

The researchers concluded: "Among patients with type 2 diabetes, use of rosiglitazone is associated with significantly higher odds of congestive heart failure, myocardial infarction, and death relative to pioglitazone in real world settings."

This systematic review finds further evidence of cardiovascular risk in diabetic patients with use of rosiglitazone

For the full abstract, click here.

BMJ 342:d1309, 17 March 2011
© 2011 BMJ Publishing Group Ltd.
Comparative cardiovascular effects of thiazolidinediones: systematic review and meta-analysis of observational studies. Yoon Kong Loke, Chun Shing Kwok, Sonal Singh. Correspondence to Y K Loke: [email protected]

Category: K. Circulatory, T. Endocrine/Metabolic/Nutritional. Keywords: rosiglitazone, pioglitazone, thiazolidinedione, cardiovascular, congestive heart failure, systematic review and meta-analysis, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 8 April 2011

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