Relationship between thiazolidinedione use and cardiovascular outcomes and all-cause mortality among patients with diabetes: A time-updated propensity analysis

Zeina A. Habib, Leonidas Tzogias, Suzannel L. Havstad, Karen Wells, George Divine, David E. Lanfear, Jeffrey Tang, Richard Krajenta, Manel Pladevall, L. Keoki Williams

Research output: Contribution to journalArticlepeer-review

42 Scopus citations

Abstract

Purpose: To investigate the association of the thiazolidinediones (TZDs), rosiglitazone, and pioglitazone, together and individually on the risk of cardiovascular outcomes and all-cause mortality, using time-updated propensity score adjusted analysis. Methods: We conducted a retrospective cohort study in a large vertically integrated health system in southeast Michigan. Cohort inclusion criteria included adult patients with diabetes treated with oral medications and followed longitudinally within the health system between 1 January 2000 and 1 December 2006. The primary outcome was fatal and non-fatal acute myocardial infarction (AMI). Secondary outcomes included hospitalizations for congestive heart failure (CHF), fatal, and non-fatal cerebrovascular accidents (CVA) and transient ischemic attacks (TIA), combined coronary heart disease (CHD) events, and all-cause mortality. Results: 19 171 patients were included in this study. Use of TZDs (adjusted hazard ratio (aHR) with propensity adjustment (PA), 0.92; 95% confidence interval (CI) 0.73-1.17), rosiglitazone (aHR with PA, 1.06; 95%CI 0.66-1.70), and pioglitazone (aHR with PA, 0.91; 95%CI 0.69-1.21) was not associated with a higher risk of AMI. However, pioglitazone use was associated with a reduction in all-cause mortality (aHR with PA, 0.60; 95%CI 0.42-0.96). Compared with rosiglitazone, pioglitazone use was associated with a lower risk of all outcomes assessed, particularly CHF (p=0.013) and combined CHD events (p=0.048). Conclusions: Our findings suggest that pioglitazone may have a more favorable risk profile when compared to rosiglitazone, arguing against a singular effect for TZDs on cardiovascular outcomes.

Original languageEnglish
Pages (from-to)437-447
Number of pages11
JournalPharmacoepidemiology and Drug Safety
Volume18
Issue number6
DOIs
StatePublished - 2009

Keywords

  • Cerebrovascular accident
  • Congestive heart failure
  • Coronary heart disease
  • Mortality
  • Thiazolidinediones

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