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Pioglitazone and cardiovascular (CV) risk

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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  • data suggests that, pioglitazone may offer less CV risk than rosiglitazone:
    • a meta-analysis (19 RCTs, n=16,390) identified a statistically significant lower risk for the com-bined outcome of death, myocardial infarction (MI) or stroke (4.4% vs. 5.7%; HR 0.82, 95%CI 0.72 to 0.94, P=0.005) for pioglitazone compared with controls (placebo or alternative oral antidiabetic therapy), but not for the individual outcome components (1)
    • a retrospective cohort study (n=29,911) found that that pioglitazone was associated with a lower risk of hospitalisation for MI than rosiglitazone (1.1% vs. 1.4%, adjusted HR 0.78, 95%CI 0.63 to 0.96) (2)

".The European Medicines Agency (EMA) issued a statement, in which they advise that the benefits of both rosiglitazone and pioglitazone in the treatment of type 2 diabetes continue to outweigh their risks. However, the statement goes on to say that prescribing information should be updated to include a warning that, in patients with ischaemic heart disease, rosiglitazone should only be used after careful evaluation of each patient's individual risk. In addition, the combination of rosiglitazone and insulin should only be used in exceptional cases and under close supervision.." (3)

Note also that glitazone therapy is associated with an increased heart failure risk:

  • study evidence suggests that about 1 in every 50 patients taking a glitazone for 26 months would experience heart failure compared with those taking placebo or another oral antidiabetic agent (3)


  • (1) Lincoff AM, Wolski K, Nicholls SJ, et al. Pioglitazone and risk of cardiovascular events in patients with type 2 diabetes mellitus. A meta-analysis of randomised controlled trials. JAMA 2007;298:1180-8
  • (2) Gerrits CM, Bhattacharya M, Manthena S, et al. A comparison of pioglitazone and rosiglitazone for hospitalization for acute myocardial infarction in type 2 diabetes. Pharmacoepidemiol Drug Saf 2007;16:1065-71
  • (3) MeReC Extra (November 2007); 30.

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