Risk of acute myocardial infarction in patients treated with thiazolidinediones or other antidiabetic medications.
OBJECTIVE
Controversy surrounds the question whether thiazolidinediones (TZDs) increase the risk of acute myocardial infarction (AMI). This study examined risk of AMI in patients with type 2 diabetes mellitus (T2DM) who were taking TZDs or other antidiabetic medications.


METHODS
Using a nested case-control design, a cohort of patients aged 18-84 years with T2DM and use of an oral antidiabetic medication or exenatide between January 2002 and June 2006 was identified. Cases of AMI were matched with up to four controls based on age, gender, health plan, geography, and diabetes therapy regimen. Over the 1-year pre-index period, TZD exposure was compared with no TZD exposure, after adjustment for potential confounders.


RESULTS
Overall, 1681 cases were identified and matched with 6653 controls. Compared with no TZD exposure, an increased risk of AMI was not observed among TZD exposed patients (adjusted OR 1.01; 95%CI, 0.85-1.20; adjusted p = 0.98). When exposure proximity to the event was examined, the risk of AMI was significantly increased with recent rosiglitazone exposure between 1 and 60 days prior to the case date (adjusted OR 1.69; 95%CI, 1.18-2.44; adjusted p = 0.045) and was not significantly increased with current or remote rosiglitazone exposure or current, recent, or remote pioglitazone exposure.


CONCLUSIONS
TZD exposure did not increase the risk of AMI when exposure proximity was not considered. However, when evaluating exposure proximity to the event, the risk of AMI was increased with recent rosiglitazone exposure between 1 and 60 days prior to the case date.
Stockl
Karen M
KM
Clinical Analytics, Clinical Services Department, Prescription Solutions, 2300 Main Street, Mail Stop CA134-0404, Irvine, CA 92614, USA. Karen.stockl@prescriptionsolutions.com
Le
Lisa
L
Zhang
Shaoang
S
Harada
Ann S M
AS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000453:epidemiology; D012044:Regression Analysis; D012306:Risk; D045162:Thiazolidinediones / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology; D055815:Young Adult
D007004:Hypoglycemic Agents; D045162:Thiazolidinediones