Pioglitazone and Heart Failure: Results From a Controlled Study in Patients With Type 2 Diabetes Mellitus and Systolic Dysfunction

Giles, Thomas D.; Miller, Alan B.; Elkayam, Uri; Bhattacharya, Mondira; Pérez, Alfonso

doi:10.1016/j.cardfail.2008.02.007

Cited by 86 publications

(74 citation statements)

References 20 publications

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“…15 However, this is the first study to compare the risk of HF between metformin and both pioglitazone and rosiglitazone as they are used in real-world practice in a highrisk Medicaid population. In accordance with most (but not all) prior studies, 4,8,9,10,12,15,40 the results show that the risk of HF was higher in rosiglitazone patients compared with pioglitazone patients: 53% (P = 0.056) higher in the multivariate model and 78% (P = 0.023) higher in the propensity-matched sample.…”

Section: Limitationssupporting

confidence: 91%

“…Since their market release, there has been a significant body of evidence confirming the risk of developing HF with TZDs. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] While the magnitude of risk varies among the different studies, rosiglitazone has been associated with greater risk of HF compared with pioglitazone. 9,11,17 Rosiglitazone has also been associated in meta-analyses with increased risk for myocardial infarctions (MI) and cardiovascular mortality.…”

mentioning

confidence: 99%

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Development of Heart Failure in Medicaid Patients with Type 2 Diabetes Treated with Pioglitazone, Rosiglitazone, or Metformin

Breunig

Shaya²,

McPherson³

et al. 2014

JMCP

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BACKGROUND: Medicaid covers a high-risk population typically underrepresented in clinical trial data and largely absent in observational studies of real-world cardiovascular risks associated with thiazolidinediones (TZDs), such as pioglitazone and rosiglitazone, which are used to manage type 2 diabetes. In November 2013, the FDA removed prescribing restrictions for rosiglitazone in light of new evidence that rosiglitazone did not increase the risk of heart attack compared with standard type 2 diabetes medications. Further investigation is needed to elucidate whether the risk of heart failure (HF) associated with TZDs may be exacerbated in the Medicaid population.

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Section: Limitationssupporting

confidence: 91%

mentioning

confidence: 99%

Development of Heart Failure in Medicaid Patients with Type 2 Diabetes Treated with Pioglitazone, Rosiglitazone, or Metformin

Breunig

Shaya²,

McPherson³

et al. 2014

JMCP

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show abstract

“…Early postmarketing data and data from randomized, controlled trials reported increased edema and weight gain in patients receiving thiazolidinediones with preexisting cardiac disease and in those with no history of HF. [39][40][41][42] In the DREAM 51 found that patients receiving pioglitazone (n=262) had an earlier time to the onset of HF and a higher incidence of the composite of cardiovascular mortality and hospitalization or emergency room visits for HF compared with those receiving glyburide (13% versus 8%, respectively; P=0.024). The 2016 American Diabetes Association standards of medical care recommend avoiding thiazolidinediones in patients with symptomatic HF.…”

Section: Thiazolidinedionesmentioning

confidence: 99%

Drugs That May Cause or Exacerbate Heart Failure

Page¹,

O’Bryant²,

Cheng³

et al. 2016

Circulation

349

185

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Heart failure is a common, costly, and debilitating syndrome that is associated with a highly complex drug regimen, a large number of comorbidities, and a large and often disparate number of healthcare providers. All of these factors conspire to increase the risk of heart failure exacerbation by direct myocardial toxicity, drug-drug interactions, or both. This scientific statement is designed to serve as a comprehensive and accessible source of drugs that may cause or exacerbate heart failure to assist healthcare providers in improving the quality of care for these patients.

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“…160 Prospective, randomized, controlled studies specifically in patients with established HF and diabetes mellitus have demonstrated increased rates of edema, a need for increased HF medications, and increased HF hospitalization in patients treated with thiazolidinediones compared with patients treated with placebo or sulfonylurea. 161,162 Given these findings, caution is urged for the use of thiazolidinediones in all patients with signs and symptoms of HF, and initiation of either agent is contraindicated in patients with NYHA class III to IV HF 155,163 (Table 6). Sulfonylureas are commonly used in diabetic patients with HF.…”

Section: Safety and Efficacy Of Antihyperglycemic Drugs In Patients Wmentioning

confidence: 99%

Contributory Risk and Management of Comorbidities of Hypertension, Obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure: A Scientific Statement From the American Heart Association

Bozkurt¹,

Aguilar²,

Deswal³

et al. 2016

Circulation

353

220

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CLINICAL STATEMENTS AND GUIDELINESfailed to show a significant reduction of SBP in patients with resistant hypertension. 81 Other strategies such as targeting excessive sympathetic nerve activity by carotid body denervation are awaiting clinical validation in the hypertension and HF populations. Drugs to Avoid in Patients With HFSeveral classes of drugs should be avoided in patients with HFrEF with a history of hypertension. Because of their negative inotropic properties and the increased likelihood of worsening HF symptoms, the nondihydropyridine calcium channel blockers such as diltiazem and verapamil should be avoided. 8 The dihydropyridine calcium channel blocker amlodipine appeared to be safe in patients with severe HFrEF in the PRAISE trial (Prospective Randomized Amlodipine Survival Evaluation), 82 as was felodipine. 73 In the current 2013 HF guidelines, most calcium channelblocking drugs except amlodipine are not recommended. 8Although clonidine is an effective antihypertensive agent, a similar centrally acting drug, moxonidine, was associated with increased mortality in patients with HF; thus, centrally acting norepinephrine-depleting agents may need to be avoided or used with caution in patients with HFrEF. 83In the ALLHAT trial, the α-blocker doxazosin arm of the trial was discontinued because of a 2-fold increase in the risk of developing HF compared with chlorthalidone treatment. 45 Although the ALLHAT study excluded patients with established HF and there are caveats about extrapolating these data to the management of hypertension in patients with established HF, the safety and efficacy of α-blockers in the management of patients with HF with hypertension are currently unclear. Potent direct-acting vasodilators such as minoxidil should also be avoided because of their renin-related salt and fluid-retaining effects. Nonsteroidal anti-inflammatory agents should be used with caution in these patients, given their effects on BP, volume status, and renal function. Treatment of Hypertension in Patients With HF With Preserved LVEFMost patients with HF and preserved LVEF (HFpEF), especially elderly women, have hypertension. A significant proportion of these patients also have evidence of LV hypertrophy, and some may have atrial dilatation, cardiac enlargement, and wall motion abnormalities without LV systolic dysfunction. Patients with HFpEF may respond particularly well to the treatment of hypertension with regression of hypertrophy 84 and improvement in filling pressures. 84,85 Most patients with HFpEF require treatment with cardiac medications for the comorbidities of hypertension, diabetes mellitus, coronary artery disease, and atrial fibrillation. The 2013 HF guidelines suggest that the use of β-blocking agents, ACE inhibitors, and ARBs in patients with hypertension is reasonable to control BP in patients with HFpEF. 8 The use of ARBs might also be considered to decrease hospitalizations for patients with HFpEF. recommendations Harmonized With Existing Guidelines for the recognition and Treatment of pa...

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Pioglitazone and Heart Failure: Results From a Controlled Study in Patients With Type 2 Diabetes Mellitus and Systolic Dysfunction

Cited by 86 publications

References 20 publications

Development of Heart Failure in Medicaid Patients with Type 2 Diabetes Treated with Pioglitazone, Rosiglitazone, or Metformin

Development of Heart Failure in Medicaid Patients with Type 2 Diabetes Treated with Pioglitazone, Rosiglitazone, or Metformin

Drugs That May Cause or Exacerbate Heart Failure

Contributory Risk and Management of Comorbidities of Hypertension, Obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure: A Scientific Statement From the American Heart Association

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