rosiglitazone new england journal of medicine

Many patients manifest CVD in form of either atherosclerotic cardiovascular disease (ASCVD) or heart failure prior to diagnosis of diabetes. It is plausible that insulin resistance may play a significant role in cardiovascular complications as well since it induces endothelial dysfunction much earlier before type 2 diabetes is diagnosed. Additionally, some antidiabetic medications were also implied to contribute to cardiovascular illness and mortality. Earlier it was believed to be due to atherosclerotic cardiovascular disease which was exaggerated by hyperglycemia. The last 10 years have changed our understanding of cardiovascular disease (CVD) risk in type 2 diabetes. In fact, treating hypertension and dyslipidemia may provide a greater benefit in reducing CV events. However, more recent studies have provided insight that HbA1c reduction may exert only a modest effect in lowering macrovascular complications. We learned from United Kingdom Prospective Diabetes Study (UKPDS) that lowering HbA1c reduces both micro and macrovascular complications. Type 2 Diabetes Mellitus, CVD, Hyperglycemia, ASCVD, Heart FailureĪBSTRACT: Eighty percent mortality occurs in patients with type 2 diabetes mellitus due to cardiovascular (CV) events like myocardial infarction, stroke and peripheral vascular disease. Įvolution in Understanding of Cardiovascular Outcomes in Diabetes New England Journal of Medicine, 356, 2457-2471. (2007) Effect of Rosiglitazone on the Risk of Myocardial Infarction and Death from Cardiovascular Causes. Despite these limitations, patients and providers should consider the potential for serious adverse cardiovascular effects of treatment with rosiglitazone for type 2 diabetes.Ĭopyright 2007 Massachusetts Medical Society.Nissen, S.E. Our study was limited by a lack of access to original source data, which would have enabled time-to-event analysis. Rosiglitazone was associated with a significant increase in the risk of myocardial infarction and with an increase in the risk of death from cardiovascular causes that had borderline significance. In the rosiglitazone group, as compared with the control group, the odds ratio for myocardial infarction was 1.43 (95% confidence interval, 1.03 to 1.98 P=0.03), and the odds ratio for death from cardiovascular causes was 1.64 (95% CI, 0.98 to 2.74 P=0.06). In the 42 trials, the mean age of the subjects was approximately 56 years, and the mean baseline glycated hemoglobin level was approximately 8.2%. the New England Journal of Medicine (NEJM) related to reports of an increased cardiovascular risk associated with rosiglitazone (marketed as Avandia). We tabulated all occurrences of myocardial infarction and death from cardiovascular causes.ĭata were combined by means of a fixed-effects model. Of 116 potentially relevant studies, 42 trials met the inclusion criteria. Criteria for inclusion in our meta-analysis included a study duration of more than 24 weeks, the use of a randomized control group not receiving rosiglitazone, and the availability of outcome data for myocardial infarction and death from cardiovascular causes. We conducted searches of the published literature, the Web site of the Food and Drug Administration, and a clinical-trials registry maintained by the drug manufacturer (GlaxoSmithKline). Rosiglitazone is widely used to treat patients with type 2 diabetes mellitus, but its effect on cardiovascular morbidity and mortality has not been determined.

Rosiglitazone new england journal of medicine