Rosiglitazone and Cardiovascular Outcomes: Is There a Clear Answer?
Diabetes is a common chronic disease that is characterized and defined by an elevated glucose level and that has grown in prevalence by 75% in the United States during a 20 year period ending in 20101. The exact reason for this rising prevalence is not known with certainty; however a large body of evidence implicates changes in weight, caloric consumption, reduced physical activity and migration to urban versus rural dwellings. Regardless of the reasons for this growth, epidemiologic studies and analyses of administrative databases have repeatedly shown that people with diabetes are 2-3 times more likely to experience fatal and nonfatal cardiovascular outcomes than people without diabetes2. This high risk was the basis for the intentional inclusion of ambulatory adults with diabetes in a large number of recent cardiovascular outcomes trials that either recruited large subpopulations or people with diabetes or were wholly restricted to people with diabetes. These trials showed that therapies that were shown to be cardioprotective in people without diabetes will also reduce cardiovascular outcomes in ambulatory people with diabetes. These include blood pressure lowering3, LDL lowering with statins4, ACE inhibitors5 or angiotensin receptor blockers6 and bypass surgery7. During the same period other therapies were shown to have a neutral effect on cardiovascular outcomes in people with diabetes including vitamin E8, omega 3 fatty acids9, and basal insulin10.
- Received July 8, 2013.
- Accepted July 9, 2013.