A comparison of pioglitazone and rosiglitazone for hospitalization for acute myocardial infarction in type 2 diabetes

Abstract

Background Recent studies have raised concerns about potential increased cardiovascular (CV) risk in type 2 diabetes patients treated with some peroxisome proliferator-activated receptor gamma (PPAR-gamma) agonists. Objective To ascertain the risk of hospitalization for acute myocardial infarction (AMI) in type 2 diabetes patients treated with pioglitazone relative to rosiglitazone. Methodology Using data covering 2003-2006 from a large health care insurer in the US, a retrospective cohort study was conducted in patients who initiated treatment with pioglitazone or rosiglitazone. The hazard ratio (HR) of incident hospitalization for AMI after initiation of treatment with these drugs was estimated from multivariate Cox's proportional hazards survival analysis; similarly, the HR was ascertained for hospitalization for the composite endpoint of AMI or coronary revascularization (CR). Results A total of 29 911 eligible patients were identified in the database; 14 807 in the pioglitazone and 15 104 in the rosiglitazone group. Baseline demographics, medical history, and dispensed medications were generally well balanced between groups. The unadjusted HR for hospitalization for AMI was 0.82, 95%CI: 0.67-1.01. After adjustment for baseline covariates the HR was 0.78, 95%CI: 0.63-0.96. The adjusted HR for the composite of AMI or CR was 0.85, 95%CI: 0.75-0.98. Conclusion This retrospective cohort study showed that pioglitazone, in comparison with rosiglitazone, is associated with a 22% relative risk reduction of hospitalization for AMI in patients with type 2 diabetes. KEY POINTS pioglitazone, in comparison to rosiglitazone, is associated with a 22% relative risk reduction of myocardial infarction. pioglitazone, in comparison to rosiglitazone, is associated with a 15% relative risk reduction of the composite endpoint of myocardial infarction or coronary revascularization.

Type 2 diabetes, thiazolidinediones, and cardiovascular risk

“…16 However, if rosiglitazone increases the risk of myocardial infarction, this may represent a neutral rather than protective effect of pioglitazone.…”

The importance of treating multiple cardiometabolic risk factors in patients with Type 2 diabetes

“…The results of the RECORD (Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycaemia in Diabetes) interim analysis and other meta-analyses showed that the risk of MI was significantly increased with rosiglitazone [71][72][73][74] . At present, it is not clear if there are differences between the two glitazones and whether or not any such potential variability is clinically relevant [71][72][73][74] .…”

Stroke and cardiovascular morbidity and mortality associated with rosiglitazone use in elderly diabetic patients

“…Since their publication, which has been widely criticised methodologically, 5 several studies have tried to confirm or contradict their results. Shortly after June 2007, a large cohort study 6,7 showed no statistically significant difference in the risk of AMI associated with rosiglitazone compared with other therapies (metformin, sulphonylurea), while another large retrospective cohort study 8 showed a significant AMI relative risk reduction among pioglitazone users compared with rosiglitazone users. In September 2007, another meta-analysis 9 of randomised clinical trials confirmed an increased risk of myocardial infarction without an increased risk of cardiovascular mortality among rosiglitazone users, and in December 2007, a Canadian nested case-control study 10 also revealed a significant increased risk of CHF, AMI and death in TZD users compared with other oral hypoglycaemic agent combination therapies, but this appeared limited to rosiglitazone.…”