Recent meta-analyses suggest an increased risk of acute myocardial infarction (AMI) in patients with type 2 diabetes mellitus (T2DM) treated with rosiglitazone. These meta-analyses have drawn considerable criticisms. Retrospective observational studies do not consistently support this association. The objective of this study was to compare rates of adverse cardiovascular outcomes in T2DM patients treated with rosiglitazone alone or combined with metformin or metformin alone. This retrospective study, using the health maintenance organization database, included patients who were dispensed rosiglitazone (alone or with metformin) for at least 6 months as follows: rosiglitazone alone (n = 745), rosiglitazone and metformin (n = 2753), and metformin alone (n = 11 938). Adverse cardiovascular outcomes were new diagnosis of AMI, acute coronary syndrome (ACS), coronary revascularization (CRV), congestive heart failure (CHF), and all-cause mortality. Mean on-treatment follow-up was 30 months. After adjustment for covariates found to be significant in univariate analyses, rosiglitazone was associated only with CHF (hazard ratio [HR] = 2.23; 95% confidence interval [CI]: 1.41-1.95) with no increase of risk for AMI (HR = 1.13; 95%CI: 0.60-2.12), ACS (HR = 0.85; 95% CI: 0.57-1.26), coronary revascularization (HR = 1.22; 95% CI:0.82-1.54), or all-cause mortality (HR = 1.15; 95% CI: 0.85-1.56). In this community-based cohort, 30 months of therapy with rosiglitazone treatment was associated with increased risk of CHF but was not associated with increased risk of AMI, ACS, coronary revascularization, or all-cause mortality.
Prevalence of erectile dysfunction (ED) increases with age and is associated with chronic comorbidities, such as diabetes and hypertension. Even so, ED is underdiagnosed and undertreated. This study investigated the effect of raising awareness of ED diagnosis and treatment in a community setting by physicians' education. Thirty-nine primary care physicians participated in lectures by a trained sexologist, and 20 of them also received computerized lists of their high-risk patients. We matched a control group of 39 primary care physicians who did not receive the intervention; we thus followed 1959 patients in both intervention groups and 1903 patients in the control group. During the period of 6 months before the intervention and 6 months after the intervention, no significant differences were found between the groups in diagnosis of new ED patients, in phosphodiesterase-5 inhibitor prescriptions or in referrals to urologists. We therefore suggest that sporadic lectures and computerized patient lists do not significantly affect the physician's behavior.
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