Cardiovascular risk and thiazolidinediones--what do meta-analyses really tell us?
Meta-analyses of clinical trials suggest that the use of the thiazolidinedione (TZD), rosiglitazone, in patients with type 2 diabetes mellitus may increase the risk of myocardial ischaemic events by 30-40%. Although these controversial data must be interpreted with caution, in the absence of definitive prospective cardiovascular (CV) outcomes data, they represent a prominent source of evidence concerning the CV safety of rosiglitazone. The results of meta-analyses and a large randomized-controlled CV outcomes trial provide strong evidence that pioglitazone does not increase the risk of coronary events. This article clarifies the clinical significance of these meta-analytical findings alongside other sources of evidence and assesses their impact on evolving treatment guidelines and recommendations for the use of TZDs in patients with type 2 diabetes.
Department of Medicine I, Rudolfstiftung Hospital, Vienna, Austria. guntram.schernthaner@wienkav.at
G
G
Schernthaner
R J
RJ
Chilton
D002318:Cardiovascular Diseases / Q000139:chemically induced*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D003925:Diabetic Angiopathies / Q000139:chemically induced*; D005260:Female; D006801:Humans; D008297:Male; D015201:Meta-Analysis as Topic; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D000077154:Rosiglitazone; D045162:Thiazolidinediones / Q000009:adverse effects*
D045162:Thiazolidinediones; D000077154:Rosiglitazone