Thiazolidinediones and cardiovascular outcomes

Abstract

Diabetes mellitus is associated with a number of serious microvascular and macrovascular complications that have a devastating effect on quality of life and impose a heavy burden on healthcare systems. In order to decrease the risk of diabetes-related complications, individuals with diabetes should normally receive intensive and effective treatment for all metabolic disturbances, including hyperglycaemia. Thiazolidinediones are an important part of this therapeutic armamentarium, but are currently the subject of intense scrutiny following the publication of a meta-analysis reporting increased cardiovascular risk with rosiglitazone. Based on available data, the FDA has concluded that the use of rosiglitazone for the treatment of type 2 diabetes may be associated with a greater risk of myocardial ischaemic events than placebo, metformin or sulphonylureas and have added label warnings to the prescribing information until the results of long-term cardiovascular outcome trials become available. To date, increased cardiovascular risk has not been reported with pioglitazone and indeed there is evidence suggestive of cardiovascular protection. Thiazolidinediones are effective glucose-lowering agents, complementing existing treatment approaches and thus have a continuing role to play in the management of diabetes.