Thiazolidinediones and Cardiovascular Outcomes
Thiazolidinediones and Cardiovascular Outcomes
Diabetes mellitus is associated with a number of serious microvascular and macrovascular complications that have a devastating effect on quality of life and impose a heavy burden on healthcare systems. In order to decrease the risk of diabetes-related complications, individuals with diabetes should normally receive intensive and effective treatment for all metabolic disturbances, including hyperglycaemia. Thiazolidinediones are an important part of this therapeutic armamentarium, but are currently the subject of intense scrutiny following the publication of a meta-analysis reporting increased cardiovascular risk with rosiglitazone. Based on available data, the FDA has concluded that the use of rosiglitazone for the treatment of type 2 diabetes may be associated with a greater risk of myocardial ischaemic events than placebo, metformin or sulphonylureas and have added label warnings to the prescribing information until the results of long-term cardiovascular outcome trials become available. To date, increased cardiovascular risk has not been reported with pioglitazone and indeed there is evidence suggestive of cardiovascular protection. Thiazolidinediones are effective glucose-lowering agents, complementing existing treatment approaches and thus have a continuing role to play in the management of diabetes.
Cardiovascular disease is the most common cause of morbidity and mortality in people with type 2 diabetes, and the increasing prevalence of diabetes will be closely followed by increases in cardiovascular-related morbidity and mortality. To reduce the risk of diabetes-associated complications, recommendations support multifactorial intervention aimed at achieving glycaemic control as close to normal as possible, accompanied by intensive lipid- and blood-pressure lowering.
As agents that may preserve beta-cell function and reduce insulin resistance, an independent risk factor for cardiovascular disease, the TZDs would be expected to address fundamental mechanisms in the development and progression of type 2 diabetes whilst reducing the risk of vascular damage. This review will highlight some of the data for the two currently available TZDs, pioglitazone and rosiglitazone, and consider the implications of the recent US FDA boxed warning regarding cardiovascular risk when using the latter.
Diabetes mellitus is associated with a number of serious microvascular and macrovascular complications that have a devastating effect on quality of life and impose a heavy burden on healthcare systems. In order to decrease the risk of diabetes-related complications, individuals with diabetes should normally receive intensive and effective treatment for all metabolic disturbances, including hyperglycaemia. Thiazolidinediones are an important part of this therapeutic armamentarium, but are currently the subject of intense scrutiny following the publication of a meta-analysis reporting increased cardiovascular risk with rosiglitazone. Based on available data, the FDA has concluded that the use of rosiglitazone for the treatment of type 2 diabetes may be associated with a greater risk of myocardial ischaemic events than placebo, metformin or sulphonylureas and have added label warnings to the prescribing information until the results of long-term cardiovascular outcome trials become available. To date, increased cardiovascular risk has not been reported with pioglitazone and indeed there is evidence suggestive of cardiovascular protection. Thiazolidinediones are effective glucose-lowering agents, complementing existing treatment approaches and thus have a continuing role to play in the management of diabetes.
Cardiovascular disease is the most common cause of morbidity and mortality in people with type 2 diabetes, and the increasing prevalence of diabetes will be closely followed by increases in cardiovascular-related morbidity and mortality. To reduce the risk of diabetes-associated complications, recommendations support multifactorial intervention aimed at achieving glycaemic control as close to normal as possible, accompanied by intensive lipid- and blood-pressure lowering.
As agents that may preserve beta-cell function and reduce insulin resistance, an independent risk factor for cardiovascular disease, the TZDs would be expected to address fundamental mechanisms in the development and progression of type 2 diabetes whilst reducing the risk of vascular damage. This review will highlight some of the data for the two currently available TZDs, pioglitazone and rosiglitazone, and consider the implications of the recent US FDA boxed warning regarding cardiovascular risk when using the latter.
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