Pioglitazone and Rosiglitazone: Different Effects on Heart Disease

Pioglitazone and Rosiglitazone: Different Effects on Heart Disease


Physician's First Watch for September 12, 2007


Two new meta-analyses in JAMA confirm the increased risk for heart failure associated with pioglitazone and rosiglitazone, but they show disparate results for other cardiovascular outcomes.

In an analysis of data from 19 randomized controlled trials involving some 16,000 patients with type 2 diabetes, those randomized to pioglitazone showed an 18% reduced risk for the composite of death, MI, and stroke. There was also a nonsignificant reduction in risk for MI alone. The drug manufacturer contributed all data.

Another research group analyzed four long-term, randomized controlled trials of rosiglitazone in which cardiovascular safety was a prespecified endpoint; some 14,000 patients were included. Overall, rosiglitazone increased the risk for MI by 42%.

Editorialists note that the increased risk for MI observed with rosiglitazone is similar to the risk reported in a recent, much publicized meta-analysis. They add that "with many other available oral agents for diabetes, the potential benefit of [thiazolidinediones] requires reevaluation."


JAMA article on pioglitazone (Free abstract; full text requires subscription)


JAMA article on rosiglitazone (Free abstract; full text requires subscription)


JAMA editorial (Subscription required)