Thiazolidinediones, cardiovascular disease and cardiovascular mortality: translating research into action for diabetes (TRIAD) - PubMed (original) (raw)

Comparative Study

doi: 10.1002/pds.1954.

Laura N McEwen, Morton B Brown, Joe V Selby, Andrew J Karter, David G Marrero, Victoria C Hsiao, Chien-Wen Tseng, Carol M Mangione, Norman L Lasser, Jesse C Crosson, William H Herman

Affiliations

Comparative Study

Thiazolidinediones, cardiovascular disease and cardiovascular mortality: translating research into action for diabetes (TRIAD)

Dori Bilik et al. Pharmacoepidemiol Drug Saf. 2010 Jul.

Abstract

Background: Studies have associated thiazolidinedione (TZD) treatment with cardiovascular disease (CVD) and questioned whether the two available TZDs, rosiglitazone and pioglitazone, have different CVD risks. We compared CVD incidence, cardiovascular (CV), and all-cause mortality in type 2 diabetic patients treated with rosiglitazone or pioglitazone as their only TZD.

Methods: We analyzed survey, medical record, administrative, and National Death Index (NDI) data from 1999 through 2003 from Translating Research Into Action for Diabetes (TRIAD), a prospective observational study of diabetes care in managed care. Medications, CV procedures, and CVD were determined from health plan (HP) administrative data, and mortality was from NDI. Adjusted hazard rates (AHR) were derived from Cox proportional hazard models adjusted for age, sex, race/ethnicity, income, history of diabetic nephropathy, history of CVD, insulin use, and HP.

Results: Across TRIAD's 10 HPs, 1,815 patients (24%) filled prescriptions for a TZD, 773 (10%) for only rosiglitazone, 711 (10%) for only pioglitazone, and 331 (4%) for multiple TZDs. In the seven HPs using both TZDs, 1,159 patients (33%) filled a prescription for a TZD, 564 (16%) for only rosiglitazone, 334 (10%) for only pioglitazone, and 261 (7%) for multiple TZDs. For all CV events, CV, and all-cause mortality, we found no significant difference between rosiglitazone and pioglitazone.

Conclusions: In this relatively small, prospective, observational study, we found no statistically significant differences in CV outcomes for rosiglitazone- compared to pioglitazone-treated patients. There does not appear to be a pattern of clinically meaningful differences in CV outcomes for rosiglitazone- versus pioglitazone-treated patients.

(c) 2010 John Wiley & Sons, Ltd.

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Conflict of interest statement

FINANCIAL DISCLOSURES: Dr. Herman has served as a consultant to and received honoraria from GlaxoSmithKline. The other authors report no conflicts of interest.

Figures

Figure 1

Figure 1. Study Population

Figure 2

Figure 2. Adjusted* Hazard Ratios among Patients with Type 2 Diabetes Treated with Rosiglitazone or Pioglitazone, TRIAD 1999-2003

*Adjusted for age, sex, race/ethnicity, income, history of diabetic nephropathy, history of cardiovascular disease (transient ischemic attack, cerebrovascular accident, angina pectoris, myocardial infarction, congestive heart failure, coronary heart disease, peripheral vascular disease), insulin use, and health plan.

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