Beneficial Effects of Thiazolidinediones on Myocardial Infarction Risk in Patients with Type 2 Diabetes
Abstract Number: 1009-P
Authors: CAROL E. KORO, QINGGONG FU, RIAD G. DIRANI, DONALD O. FEDDER
Institutions: Upper Providence, PA; Baltimore, MD
Results: Type 2 diabetes is associated with increased cardiovascular risk. Thiazolidinediones (TZDs), effective antidiabetic agents, have been shown to improve insulin sensitivity, enhance endothelial function and reduce mediators of prothrombotic activity and inflammatory markers of cardiovascular risk. A case-control study was conducted to determine whether TZDs alter the risk of myocardial infarction (MI) compared to traditional antidiabetic agents.
Incident cases of MI hospitalizations among type 2 diabetic patients were identified from the Integrated Healthcare Information Services (IHCIS) managed care database from 1997 and 2002. Patients with prior MI were excluded. Six controls were matched to each case on age, gender and calendar year of MI diagnosis (index year). The odds of MI were modeled using conditional logistic regression, adjusting for age, gender, index-year, Nitrate use, ACE inhibitors, Beta-blockers, diuretics, hyperlipidemia and hypertension.
Two hundred and twenty nine incident cases of MI hospitalizations were matched to 1,374 controls. Compared to insulin monotherapy, TZD use was associated with 49% reduction in the risk of MI (95% CI = 0.27-0.95). Among specific TZDs, the adjusted odds ratio for rosiglitazone on MI risk was 0.43 (95% CI = 0.19-0.97) and that for pioglitazone was 0.61 (95% CI = 0.27-1.39).
TZD use is associated with a reduction in MI risk in type 2 diabetes. This potentially translates into economic benefit. Numerous outcomes studies are in progress to prospectively confirm these findings.
Risk of MI in users of various antidiabetic agents in IHCIS.
|Reference group = Insulin monotherapy|
|Controls n=1374||Cases n=229||Adjusted OR (95% CI)|
|Oral Dual Combinations|
|Metformin with SU||221||27||0.56 (0.33-0.95)|