George A. Diamond, MD; Leon Bax, MSc; Sanjay Kaul, MD
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Sanjay Kaul, MD, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048; e-mail, email@example.com.
Current Author Addresses: Dr. Diamond: 2408 Wild Oak Drive, Los Angeles, CA 90068; e-mail, firstname.lastname@example.org.
Mr. Bax: Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, the Netherlands, and Department of Medical Informatics, Kitasato University, Kitasato 1-15-1, Sagamihara 228-8555, Japan; e-mail, email@example.com.
Dr. Kaul: Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048; e-mail, firstname.lastname@example.org.
A recent, widely publicized meta-analysis of 42 clinical trials concluded that rosiglitazone was associated with an approximately 43% increased risk for myocardial infarction and an approximately 64% increased risk for cardiovascular death. The sensitivity of these conclusions to several methodological choices was not assessed. The meta-analysis was not based on a comprehensive search for all studies that might yield evidence about rosiglitazone's cardiovascular effects. Studies were combined on the basis of a lack of statistical heterogeneity, despite substantial variability in study design and outcome assessment. The meta-analytic approach that was used required the exclusion of studies with zero events in the treatment and control groups. Alternative meta-analytic approaches that use continuity corrections show lower odds ratios that are not statistically significant. We conclude that the risk for myocardial infarction and death from cardiovascular disease for diabetic patients taking rosiglitazone is uncertain: Neither increased nor decreased risk is established.
Table 1. Meta-analytic Odds Ratios for Myocardial Infarction and Cardiovascular Death
Table 2. Meta-analytic Odds Ratios for Subgroups
Appendix Table. Sample Application of Continuity Corrections
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
George A. Diamond, Leon Bax, Sanjay Kaul. Uncertain Effects of Rosiglitazone on the Risk for Myocardial Infarction and Cardiovascular Death. Ann Intern Med. 2007;147:578–581. doi: 10.7326/0003-4819-147-8-200710160-00182
Download citation file:
Published: Ann Intern Med. 2007;147(8):578-581.
Acute Coronary Syndromes, Cardiology, Coronary Heart Disease, Emergency Medicine.
Results provided by:
Copyright © 2017 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use