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- Title
Thiazolidinediones and Cardiovascular Outcomes in Older Patients With Diabetes.
- Authors
Lipscombe, Lorraine L.; Gomes, Tara; Levesque, Linda E.; Hux, Janet E.; Juurlink, David N.; Alter, David A.
- Abstract
Context: Thiazolidinediones (TZDs), used to treat type 2 diabetes, are associated with an excess risk of congestive heart failure and possibly acute myocardial infarction. However, the association between TZD use and cardiovascular events has not been adequately evaluated on a population level. Objective: To explore the association between TZD therapy and congestive heart failure, acute myocardial infarction, and mortality compared with treatment with other oral hypoglycemic agents. Design, Setting, and Patients: Nested case-control analysis of a retrospective cohort study using health care databases in Ontario. We included diabetes patients aged 66 years or older treated with at least 1 oral hypoglycemic agent between 2002 and 2005 (N = 159 026) and followed them up until March 31, 2006. Main Outcome Measures: The primary outcome consisted of an emergency department visit or hospitalization for congestive heart failure; secondary outcomes were an emergency department visit or hospitalization for acute myocardial infarction and all-cause mortality. The risks of these events were compared between persons treated with TZDs (rosiglitazone and pioglitazone) and other oral hypoglycemic agent combinations, after matching and adjusting for prognostic factors. Results During a median follow-up of 3.8 years, 12 491 patients (7.9%) had a hospital visit for congestive heart failure, 12 578 (7.9%) had a visit for acute myocardial infarction, and 30 265 (19%) died. Current treatment with TZD monotherapy was associated with a significantly increased risk of congestive heart failure (78 cases; adjusted rate ratio [RR], 1.60; 95% confidence interval [CI], 1.21-2.10; P<.001), acute myocardial infarction (65 cases; RR, 1.40; 95% CI, 1.05-1.86; P=.O2), and death (102 cases; RR, 1.29; 95% CI, 1.02-1.62; P=.03) compared with other oral hypoglycemic agent combination therapies (3478 congestive heart failure cases, 3695 acute myocardial infarction cases, and 5529 deaths). The increased ri
- Subjects
PEOPLE with diabetes; DRUG side effects; PREVENTION of diabetes complications; CONGESTIVE heart failure; MYOCARDIAL infarction risk factors; PHARMACODYNAMICS; BLOOD sugar; ENDOCRINE diseases; MORTALITY; DISEASE risk factors
- Publication
JAMA: Journal of the American Medical Association, 2007, Vol 298, Issue 22, p2634
- ISSN
0098-7484
- Publication type
Article
- DOI
10.1001/jama.298.22.2634