Adverse cardiovascular events during treatment with pioglitazone and rosiglitazone: population based cohort study

doi:10.1136/bmj.b2942

Published 18 August 2009, doi:10.1136/bmj.b2942
Cite this as: BMJ 2009;339:b2942

Research

Adverse cardiovascular events during treatment with pioglitazone and rosiglitazone: population based cohort study

David N Juurlink, division head¹^,2^,3^,4^,5, Tara Gomes, epidemiologist⁵, Lorraine L Lipscombe, assistant professor⁵^,6, Peter C Austin, senior scientist⁴^,5^,7, Janet E Hux, senior scientist¹^,2^,4^,5, Muhammad M Mamdani, centre director²^,4^,5^,8

¹ Division of Clinical Pharmacology and Toxicology, Department of Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, Canada M4N 3M5, ² Department of Medicine, University of Toronto, ³ Department of Pediatrics, University of Toronto, ⁴ Department of Health Policy, Management, and Evaluation, University of Toronto, ⁵ Institute for Clinical Evaluative Sciences, Toronto, ⁶ Women’s College Hospital, Toronto, ⁷ Department of Public Health Sciences, University of Toronto, ⁸ Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto

Correspondence to: D Juurlink dnj{at}ices.on.ca

Objective To compare the risk of acute myocardial infarction,heart failure, and death in patients with type 2 diabetes treatedwith rosiglitazone and pioglitazone.

Design Retrospective cohort study.

Setting Ontario, Canada.

Participants Outpatients aged 66 years and older who were startedon rosiglitazone or pioglitazone between 1 April 2002 and 31March 2008.

Main outcome measure Composite of death or hospital admissionfor either acute myocardial infarction or heart failure. Ina secondary analysis, each outcome was also examined individually.

Results 39 736 patients who started on either pioglitazone orrosiglitazone were identified. During the six year study period,the composite outcome was reached in 895 (5.3%) of patientstaking pioglitazone and 1563 (6.9%) of patients taking rosiglitazone.After extensive adjustment for demographic and clinical factorsand drug doses, pioglitazone treated patients had a lower riskof developing the primary outcome than did patients treatedwith rosiglitazone (adjusted hazard ratio 0.83, 95% confidenceinterval 0.76 to 0.90). Secondary analyses revealed a lowerrisk of death (adjusted hazard ratio 0.86, 0.75 to 0.98) andheart failure (0.77, 0.69 to 0.87) with pioglitazone but nosignificant difference in the risk of acute myocardial infarction(0.95, 0.81 to 1.11). One additional composite outcome wouldbe predicted to occur annually for every 93 patients treatedwith rosiglitazone rather than pioglitazone.

Conclusions Among older patients with diabetes, pioglitazoneis associated with a significantly lower risk of heart failureand death than is rosiglitazone. Given that rosiglitazone lacksa distinct clinical advantage over pioglitazone, continued useof rosiglitazone may not be justified.

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