Ananda Basu, MD
What is the relative cardiovascular safety of pioglitazone and rosiglitazone in older patients with diabetes?
Population-based cohort study using linkage of a public plan prescription records database with a national ambulatory care reporting system, a discharge abstract database, and the Ontario health insurance database; median follow-up was 294 days for patients on pioglitazone and 292 days for those on rosiglitazone.
39 736 Ontario residents ≥ 66 years of age who started treatment with pioglitazone (n = 16 951) or rosiglitazone (n = 22 785) during a 6-year period. Exclusion criteria were prescription of either drug before the study index date and concurrent use of insulin.
Initiation of treatment with pioglitazone or rosiglitazone.
A composite of all-cause death or hospital admission or emergency department visit for acute myocardial infarction or heart failure; and individual components of the composite outcome.
Patients who started treatment with pioglitazone had lower risk for the composite outcome, death, and heart failure than did patients who started treatment with rosiglitazone; groups did not differ for myocardial infarction (Table).
In older patients with diabetes, starting treatment with pioglitazone instead of rosiglitazone was associated with lower risk for a composite of death or admission for heart failure or myocardial infarction, as well as death and heart failure.
Relative cardiovascular safety of pioglitazone and rosiglitazone in older patients with diabetes*
*NS = not significant; other abbreviations defined in Glossary.
†Adjusted for age, sex, duration of diabetes, long-term care residence, socioeconomic status, comorbid conditions, and use of other specified drugs.
‡Estimate derived from Cox proportional hazards model (inverse of marginal risk difference between pioglitazone and rosiglitazone at 1 y).
§All-cause death or hospital admission or emergency department visit for acute myocardial infarction or heart failure.
Basu A. Pioglitazone was associated with lower risk for adverse cardiovascular events than rosiglitazone in older patients. Ann Intern Med. ;152:JC2–13. doi: 10.7326/0003-4819-152-4-201002160-02013
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Published: Ann Intern Med. 2010;152(4):JC2-13.
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