Abstract 3732: Pioglitazone and cardiovascular outcomes
Background: A recent meta-analysis suggested that the use of Rosiglitazone increases the risk of myocardial infarction (MI) in patients with type 2 diabetes mellitus. It is unclear if this is a class effect of thiazolidinediones (TZD). We did a meta-analysis to evaluate cardiovascular outcomes with the use of Pioglitazone.
Methods: Randomized controlled trials in which Pioglitazone was compared to placebo or other hypoglycemic agents were considered for analysis. Studies were included if the data for MI was available. Studies were obtained using relevant search words in Medline, Pubmed, EMBASE, CINAHL and Cocrane databases. Data abstraction was done by 2 individual authors using a standardized protocol. The relative risk across all study groups was computed using the Mantel-Haenszel method and interstudy heterogeneity was assessed by Chi square method. All results were computed using 95% confidence intervals.
Results: 5 trials (N=9965) met the inclusion criteria for analysis. The relative risk for MI was 0.85 (0.68–1.07, p=0.17). The relative risks for unstable coronary events (MI + unstable angina) and revascularization were 0.79 (0.65–0.97, p=0.03) and 0.81 (0.67–0.98, p=0.03) respectively. The relative risk for the combined primary endpoint comprising of death, MI, stroke and revascularization was 0.85 (0.76–0.95, p=0.003)
Conclusion: Unlike Rosiglitazone, Pioglitazone does not increase the risk for MI and significantly decreases the risk for unstable coronary syndromes, revascularization and major adverse cardiac outcomes. This benefit of Pioglitazone might be explained by its relatively favorable effects on the lipid profile (compared to Rosiglitazone).