title: Variation in Association Between Thiazolidinediones and Heart Failure Across Ethnic Groups: Retrospective analysis of Large Healthcare Claims Databases in Six Countries.
abstract: BACKGROUND
  The prevalence of polymorphisms among the metabolising enzymes and pharmacodynamic receptors relevant for the thiazolidinediones differs by ethnic group, a factor that may modify risk of adverse drug events.
  
  
  OBJECTIVE
  The aim of the study was to determine if the risk of oedema or heart failure associated with the thiazolidinediones varies in populations in Australia, Canada, Hong Kong, Japan, Korea and Taiwan.
  
  
  METHODS
  Sequence symmetry analyses were undertaken to investigate the risk of peripheral oedema, as measured by incident furosemide dispensing, and risk of hospitalisations for heart failure. Results were pooled, with Australia and Canada representing predominantly Caucasian population and all other countries contributing to Asian population estimates.
  
  
  RESULTS
  Pooled estimates of risk for furosemide initiation in the Caucasian populations were significantly increased for pioglitazone [adjusted sequence ratio (ASR) 1.47; 95 % confidence interval (CI) 1.14-1.91] and rosiglitazone (ASR 1.65; 95 % CI 1.58-1.72), while in the Asian populations, the pooled risk estimates were lower (ASR 1.11; 95 % CI 0.93-1.32 and ASR 1.21; 95 % CI 1.01-1.45 for pioglitazone and rosiglitazone, respectively). Results for hospitalisation for heart failure showed a similar trend, with elevated risk in the Australian data (ASR 1.88; 95 % CI 1.01-3.5 and ASR 1.25; 95 % CI 0.76-2.05 for pioglitazone and rosiglitazone, respectively), while no increased risk was found in the pooled results for the Asian populations.
  
  
  CONCLUSIONS
  The risk of both oedema and heart failure with thiazolidinediones was higher in predominantly Caucasian countries than in the Asian countries assessed. Assessment of adverse events by ethnicity may support safer medicine use.
authors.affiliation: Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia.
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Roughead
authors.forename: Esther W
authors.initials: EW
authors.lastname: Chan
authors.forename: Nam-Kyong
authors.initials: NK
authors.lastname: Choi
authors.forename: Michio
authors.initials: M
authors.lastname: Kimura
authors.forename: Tomomi
authors.initials: T
authors.lastname: Kimura
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Kubota
authors.forename: Edward Chia-Cheng
authors.initials: EC
authors.lastname: Lai
authors.forename: Kenneth K C
authors.initials: KK
authors.lastname: Man
authors.forename: Tuan Anh
authors.initials: TA
authors.lastname: Nguyen
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Ooba
authors.forename: Byung-Joo
authors.initials: BJ
authors.lastname: Park
authors.forename: Tsugumichi
authors.initials: T
authors.lastname: Sato
authors.forename: Ju-Young
authors.initials: JY
authors.lastname: Shin
authors.forename: TongTong
authors.initials: T
authors.lastname: Wang
authors.forename: Jenna
authors.initials: J
authors.lastname: Griffiths
authors.forename: Ian C K
authors.initials: IC
authors.lastname: Wong
authors.forename: Yea-Huei Kao
authors.initials: YH
authors.lastname: Yang
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Pratt
mesh_terms: D016208:Databases, Factual; D004487:Edema / Q000139:chemically induced* / Q000453:epidemiology / Q000208:ethnology; D005006:Ethnicity / Q000235:genetics / Q000706:statistics & numerical data*; D005665:Furosemide / Q000627:therapeutic use; D006333:Heart Failure / Q000139:chemically induced* / Q000453:epidemiology / Q000208:ethnology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D000077205:Pioglitazone; D011110:Polymorphism, Genetic; D012189:Retrospective Studies; D000077154:Rosiglitazone; D045162:Thiazolidinediones / Q000009:adverse effects*
chemical_list: D045162:Thiazolidinediones; D000077154:Rosiglitazone; D005665:Furosemide; D000077205:Pioglitazone