Abstract
BackgroundAccumulating evidence suggests that thiazolidinediones (TZDs) may exert protective effects in atrial fibrillation (AF). The present meta-analysis investigated the association between TZD use and the incidence of AF in diabetic patients.MethodsElectronic databases were searched until December 2016. Of the 346 initially identified records, 3 randomized clinical trials (RCTs) and 4 observational studies with 130,854 diabetic patients were included in the final analysis.ResultsPooled analysis of the included studies demonstrated that patients treated with TZDs had approximately 30% lower risk of developing AF compared to controls [odds ratio (OR): 0.73, 95% confidence interval (CI): 0.62 to 0.87, p = 0.0003]. This association was consistently observed for both new onset AF (OR =0.77, p = 0.002) and recurrent AF (OR =0.41, p = 0.002), pioglitazone use (OR =0.56, p = 0.04) but not rosiglitazone use (OR =0.78, p = 0.12). The association between TZD use and AF incidence was not significant in the pooled analysis of three RCTs (OR =0.77, 95% CI = 0.53–1.12, p = 0.17), but was significantly in the pooled analysis of the four observational studies (OR =0.71, p = 0.0003).ConclusionsThis meta-analysis suggests that TZDs may confer protection against AF in the setting of diabetes mellitus (DM). This class of drugs can be used as upstream therapy for DM patients to prevent the development of AF. Further large-scale RCTs are needed to determine whether TZDs use could prevent AF in the setting of DM.
Highlights
Accumulating evidence suggests that thiazolidinediones (TZDs) may exert protective effects in atrial fibrillation (AF)
Inclusion criteria The studies considered for this meta-analysis were either randomized clinical trials (RCTs) or observational studies that investigated the potential effects of TZDs on AF
The pooled analysis of the seven included studies suggested that patients treated with TZDs have nearly 30% lower risk of AF compared with controls (OR =0.73, 95% confidence interval (CI) = 0.62–0.87, p = 0.0003; Fig. 2)
Summary
Accumulating evidence suggests that thiazolidinediones (TZDs) may exert protective effects in atrial fibrillation (AF). Diabetes mellitus (DM) is one of the strongest independent risk factors for AF incidence, conferring an approximate 40% higher risk of subsequent AF development [2, 3]. Thiazolidinediones (TZDs), a class of peroxisome proliferator-activated receptor-γ (PPAR-γ) agonists, are among the most potent insulin-sensitizing drugs [9]. Apart from their anti-diabetic activity, TZDs display several pleiotropic effects including anti-inflammatory and antioxidant actions that may have potential benefits for AF prevention [10, 11].
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