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Relationship between thiazolidinedione use and cardiovascular outcomes and all-cause mortality among patients with diabetes: a time-updated propensity analysis†

  1. Zeina A. Habib MD1,
  2. Leonidas Tzogias MD1,
  3. Suzanne L. Havstad MA2,
  4. Karen Wells BS2,
  5. George Divine PhD2,
  6. David E. Lanfear MD, MS1,3,
  7. Jeffrey Tang MD1,
  8. Richard Krajenta BS2,
  9. Manel Pladevall MD, MS3,
  10. L. Keoki Williams MD, MPH1,2,3,*

Article first published online: 23 FEB 2009

DOI: 10.1002/pds.1722

Issue

Pharmacoepidemiology and Drug Safety

Pharmacoepidemiology and Drug Safety

Volume 18, Issue 6, pages 437–447, June 2009

Additional Information

How to Cite

Habib, Z. A., Tzogias, L., Havstad, S. L., Wells, K., Divine, G., Lanfear, D. E., Tang, J., Krajenta, R., Pladevall, M. and Williams, L. K. (2009), Relationship between thiazolidinedione use and cardiovascular outcomes and all-cause mortality among patients with diabetes: a time-updated propensity analysis. Pharmacoepidem. Drug Safe., 18: 437–447. doi: 10.1002/pds.1722

Author Information

  1. 1

    Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA

  2. 2

    Department of Biostatistics and Research Epidemiology, Henry Ford Hospital, Detroit, MI, USA

  3. 3

    Center for Health Services Research, Henry Ford Hospital, Detroit, MI, USA

*Center for Health Services Research, Henry Ford Health System, 1 Ford Place, 3A CHSR, Detroit, MI 48202, USA.

  1. †

    Zeina A. Habib and Leonidas Tzogias made an equal contribution to the manuscript.

Publication History

  1. Issue published online: 2 JUN 2009
  2. Article first published online: 23 FEB 2009
  3. Manuscript Accepted: 15 JAN 2009
  4. Manuscript Revised: 7 JAN 2009
  5. Manuscript Received: 28 APR 2008

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Keywords:

  • thiazolidinediones;
  • coronary heart disease;
  • congestive heart failure;
  • cerebrovascular accident;
  • mortality

Abstract

Purpose

To investigate the association of the thiazolidinediones (TZDs), rosiglitazone, and pioglitazone, together and individually on the risk of cardiovascular outcomes and all-cause mortality, using time-updated propensity score adjusted analysis.

Methods

We conducted a retrospective cohort study in a large vertically integrated health system in southeast Michigan. Cohort inclusion criteria included adult patients with diabetes treated with oral medications and followed longitudinally within the health system between 1 January 2000 and 1 December 2006. The primary outcome was fatal and non-fatal acute myocardial infarction (AMI). Secondary outcomes included hospitalizations for congestive heart failure (CHF), fatal, and non-fatal cerebrovascular accidents (CVA) and transient ischemic attacks (TIA), combined coronary heart disease (CHD) events, and all-cause mortality.

Results

19 171 patients were included in this study. Use of TZDs (adjusted hazard ratio (aHR) with propensity adjustment (PA), 0.92; 95% confidence interval (CI) 0.73–1.17), rosiglitazone (aHR with PA, 1.06; 95%CI 0.66–1.70), and pioglitazone (aHR with PA, 0.91; 95%CI 0.69–1.21) was not associated with a higher risk of AMI. However, pioglitazone use was associated with a reduction in all-cause mortality (aHR with PA, 0.60; 95%CI 0.42–0.96). Compared with rosiglitazone, pioglitazone use was associated with a lower risk of all outcomes assessed, particularly CHF (p = 0.013) and combined CHD events (p = 0.048).

Conclusions

Our findings suggest that pioglitazone may have a more favorable risk profile when compared to rosiglitazone, arguing against a singular effect for TZDs on cardiovascular outcomes. Copyright © 2009 John Wiley & Sons, Ltd.

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