|Rosiglitazone and Heart Disease|
|HIV Meds Quarterly Research Brief|
|Susa Coffey, MD, HIV InSite Medical Editor|
|Ian R. McNicholl, PharmD, BCPS (Added Qualifications-Infectious Diseases), HIV InSite Pharmacy Editor|
In HIV-infected patients, the thiazolidinedione medications rosiglitazone and pioglitazone have been used both for treatment of type 2 diabetes (their indication) and for treatment of lipodystrophy. However, in the general population, they have been associated with congestive heart failure (CHF) and myocardial infarction. A recent metaanalysis of 28,361 HIV-uninfected diabetic patients who initiated rosiglitazone or pioglitazone assessed the outcomes of all-cause mortality, myocardial infarction, stroke, and hospitalization for CHF. Patients were older than 65 years of age, had similar baseline characteristics, and were divided into two equal groups to receive either rosiglitazone or pioglitazone.
Cox regression modeling indicated that patients who received rosiglitazone had a 15% greater chance of mortality and a 13% greater chance of CHF than patients who received pioglitazone; these differences were statistically significant. There were no differences between groups in rates of myocardial infarction or stroke.
| Clinical Bottom Line|
Although large studies of cardiovascular outcomes involving HIV-infected patients on thiazolidinediones have not been conducted, clinicians should use caution when prescribing these drugs, particularly for older patients and those with cardiovascular risk factors. This study found that adverse cardiovascular effects result from rosiglitazone but not from pioglitazone; based on these data, pioglitazone should be used preferentially, if treatment with a thiazolidinediones is required.
- Winkelmayer WC, Setoguchi S, Levin R, et al. Comparison of cardiovascular outcomes in elderly patients with diabetes who initiated rosiglitazone vs pioglitazone therapy. Arch Intern Med. 2008 Nov 24;168(21):2368-75.