Thiazolidinediones and Cardiovascular Disease: Balancing Benefit and Harm

Sonal Singh, MD; Yoon K. Loke, MD

Disclosures

Geriatrics and Aging. 2008;11(3):179-183. 

In This Article

Abstract and Introduction

Cardiovascular disease is the leading cause of mortality among older adults with type II diabetes. The thiazolidinediones (rosiglitazone and pioglitazone) lower blood sugar levels among individuals with type II diabetes. The thiazolidinediones have favourable effects on surrogate markers of cardiovascular disease such as microalbuminuria, carotid intimal thickness, and blood pressure. Emerging evidence from recent randomized clinical trials has confirmed both that thiazolidinediones increase the risk of heart failure, and that rosiglitazone increases the risk of myocardial infarction among those with type II diabetes. Clinicians should avoid thiazolidinediones for older individuals with type II diabetes who are at risk for cardiovascular events as the negative cardiovascular effects of the thiazolidinediones outweigh any potential benefits on surrogate markers.

Cardiovascular disease is the leading cause of mortality and morbidity among persons with type II diabetes. The prevalence of coronary artery disease among individuals with type II diabetes is approximately 22%.[1] A recent prospective longitudinal prevalence study showed that the prevalence of heart failure among older adults with newly diagnosed type II diabetes over a period of 10 years of follow-up was 57.6%.[2]

The currently available thiazolidinediones are rosiglitazone and pioglitazone. These drugs lower blood sugar levels among individuals with type II diabetes. They have been shown to favourably affect surrogate markers of cardiovascular disease such as carotid intimal thickness,[3] serum C-reactive protein levels,[4] blood pressure levels,[5] and microalbuminuria.[6] However, recent systematic reviews have alerted us to the emerging cardiovascular risks of the thiazolidinediones in randomized clinical trials.[7,8,9,10,11]

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