Thiazolidinediones and Cardiovascular Disease: Balancing Benefit and Harm

Authors and Disclosures

Sonal Singh, MD, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.

Yoon K. Loke, MBBS, MD, University of East Anglia, School of Medicine, Health Policy and Practice, Norwich, UK.

Disclosure: No competing financial interests declared.

Sidebar: Key Points

Cardiovascular disease is the leading cause of morbidity and mortality among older adults with type II diabetes.
Rosiglitazone increases the risk of myocardial infarction by nearly 40% and doubles the risk of heart failure, without an increase in cardiovascular mortality.
Pioglitazone increases the risk of heart failure without an increase in the risk of ischemic events, possibly explained by differences in lipid effects.

Suggestions for Thiazolidinedione Use in Older Diabetic Adults:
Newly diagnosed older diabetic patients should not be started on a thiazolidinedione.
Both the thiazolidinediones should be avoided for older adults with type II diabetes who have heart failure or are at risk for heart failure.
Rosiglitazone should be avoided in older type II diabetic patients at risk for cardiovascular disease.
Older type II diabetic patients with poor glycemic control should be switched from a thiazolidinedione to a nonthiazolidinedione regimen.
Strong consideration should be given to switching older adults with type II diabetes well controlled on a thiazolidinedione to a nonthiazolidinedione regimen.
In a case where a clinician has exhausted all other therapeutic options, pioglitazone may be the preferred thiazolidinedione.