Document Detail


Congestive heart failure and cardiovascular death in patients with prediabetes and type 2 diabetes given thiazolidinediones: a meta-analysis of randomised clinical trials.
MedLine Citation:
PMID:  17905165     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The overall clinical benefit of thiazolidinediones (TZDs) as a treatment for hyperglycaemia can be difficult to assess because of the risk of congestive heart failure due to TZD-related fluid retention. Since prediabetic and diabetic patients are at high cardiovascular risk, the outcome and natural history of such risks need to be better understood. We aimed to examine the risk of congestive heart failure and of cardiac death in patients given TZDs. METHODS: We used a search strategy to identify 3048 studies. 3041 were excluded, and we did a systematic review and meta-analysis of the seven remaining randomised double-blind clinical trials of drug-related congestive heart failure in patients given TZDs (either rosiglitazone or pioglitazone). We calculated pooled random-effects estimates of the risk ratios for development of congestive heart failure in patients given TZDs compared with controls. The main outcome measures were development of congestive heart failure and the risk of cardiovascular death. FINDINGS: 360 of 20 191 patients who had either prediabetes or type 2 diabetes had congestive heart failure events (214 with TZDs and 146 with comparators). Results showed no heterogeneity of effects across studies (I2=22.8%; p for interaction=0.26), which indicated a class effect for TZDs. Compared with controls, patients given TZDs had increased risk for development of congestive heart failure across a wide background of cardiac risk (relative risk [RR] 1.72, 95% CI 1.21-2.42, p=0.002). By contrast, the risk of cardiovascular death was not increased with either of the two TZDs (0.93, 0.67-1.29, p=0.68). INTERPRETATION: Congestive heart failure in patients given TZDs might not carry the risk that is usually associated with congestive heart failure which is caused by progressive systolic or diastolic dysfunction of the left ventricle. Longer follow-up and better characterisation of such patients is needed to determine the effect of TZDs on overall cardiovascular outcome.
Authors:
Rodrigo M Lago; Premranjan P Singh; Richard W Nesto
Related Documents :
19910105 - Polymyositis presenting with cardiac manifestations: report of two cases and review of ...
1116395 - Evaluation of skeletal muscle capillary basement membrane thickness in congestive heart...
6870005 - Furazolidone-induced congestive cardiomyopathy in ducklings: myocardial ultrastructural...
23094875 - Magnetocardiography for the diagnosis of coronary artery disease-a systematic review an...
11193745 - Left ventricular myxoma: report of a case.
6896255 - The effects of azathioprine, clofibrate and tribenoside on leucocyte migration inhibiti...
Publication Detail:
Type:  Journal Article; Meta-Analysis; Review    
Journal Detail:
Title:  Lancet     Volume:  370     ISSN:  1474-547X     ISO Abbreviation:  Lancet     Publication Date:  2007 Sep 
Date Detail:
Created Date:  2007-10-01     Completed Date:  2007-10-09     Revised Date:  2008-04-07    
Medline Journal Info:
Nlm Unique ID:  2985213R     Medline TA:  Lancet     Country:  England    
Other Details:
Languages:  eng     Pagination:  1129-36     Citation Subset:  AIM; IM    
Affiliation:
Lahey Clinic Medical Center, Burlington, MA, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Cardiovascular Diseases / mortality*
Diabetes Complications / prevention & control*
Diabetes Mellitus, Type 2 / drug therapy*
Female
Heart Failure* / chemically induced,  etiology
Humans
Hypoglycemic Agents* / adverse effects,  therapeutic use
Male
Middle Aged
Randomized Controlled Trials as Topic
Risk Factors
Thiazolidinediones* / adverse effects,  therapeutic use
Chemical
Reg. No./Substance:
0/Hypoglycemic Agents; 0/Thiazolidinediones; 111025-46-8/pioglitazone; 122320-73-4/rosiglitazone
Comments/Corrections
Comment In:
Lancet. 2007 Sep 29;370(9593):1101   [PMID:  17905143 ]
ACP J Club. 2008 Mar-Apr;148(2):39   [PMID:  18311869 ]
Lancet. 2007 Sep 29;370(9593):1103-4   [PMID:  17905146 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Foam film permeability: theory and experiment.
Next Document:  H5N1 infection of the respiratory tract and beyond: a molecular pathology study.