Amy T. Wang, MD; Steven A. Smith, MD
Does rosiglitazone increase risk for serious cardiovascular (CV) events or mortality more than pioglitazone in older patients?
Observational cohort study using database linkage. Median follow-up was 105 days.
Medicare health insurance program in the USA.
227 571 patients ≥ 65 years of age (mean age 74 y, 60% women) who were starting treatment with rosiglitazone or pioglitazone and had continuous enrollment in Medicare Part D (drug prescriptions) for ≥ 6 months and Parts A (hospital expenses) and B (outpatient medical care) for ≥ 12 months. Exclusion criteria were current hospice care or residence in hospital or a long-term care facility.
Use of rosiglitazone.
Acute myocardial infarction (MI); stroke; heart failure; all-cause mortality; and a composite of acute MI, stroke, heart failure, or all-cause mortality.
8667 events occurred during 101 126 to 101 323 person-years of follow-up. Use of rosiglitazone was associated with increased risks for stroke; heart failure; all-cause mortality; and the composite endpoint of acute MI, stroke, heart failure, or mortality, compared with pioglitazone (Table). Groups did not differ for acute MI (Table).
In older patients, use of rosiglitazone was associated with increased risk for stroke, heart failure, and mortality, but not acute myocardial infarction, compared with pioglitazone.
Risk for CV events or mortality with use of rosiglitazone vs pioglitazone in older patients*
*CV = cardiovascular; HR = hazard ratio; MI = myocardial infarction; other abbreviations defined in Glossary.
†Stratified by history of CV endpoints and cancer and adjusted for sex; age; ethnicity; receipt of low-income subsidy; recent extended care residence; Charlson score; number of medication classes; CV disease, diabetes-related disorders, or other specified medical conditions (e.g., dementia, kidney failure) in the past 12 mo; and use of CV, diabetes-related, lipid-lowering, or other specified medications (e.g., antidepressants, proton-pump inhibitors) in the past 6 mo.
‡Acute MI, stroke, heart failure, or mortality.
Wang AT, Smith SA. In older patients, rosiglitazone was associated with increased risk for stroke, heart failure, and mortality compared with pioglitazone. Ann Intern Med. ;153:JC6–11. doi: 10.7326/0003-4819-153-12-201012210-02011
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Published: Ann Intern Med. 2010;153(12):JC6-11.
Cardiology, Geriatric Medicine, Heart Failure, Neurology, Stroke.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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