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A meta-analysis comparing the effect of thiazolidinediones on cardiovascular risk factors.
Arch Intern Med 2004; 164(19):2097-104AI

Abstract

BACKGROUND

In patients with type 2 diabetes mellitus, all therapeutic options should be evaluated for their effect on cardiovascular risk factors, in addition to glycemic control. We conducted a meta-analysis of randomized controlled trials of pioglitazone hydrochloride and rosiglitazone maleate in patients with type 2 diabetes to evaluate their effect on glycemic control, lipids, blood pressure, and weight.

METHODS

Randomized controlled trials of patients with type 2 diabetes that compared pioglitazone or rosiglitazone with placebo for 12 weeks were included. Primary analysis was to compare thiazolidinediones with placebo. Secondary analysis was to identify whether treatment with pioglitazone differed from rosiglitazone in any outcomes. We calculated weighted mean differences and 95% confidence intervals.

RESULTS

Twenty-three randomized controlled trials were identified. Both thiazolidinediones demonstrated similar hemoglobin A(1c) level decreases of 1.0% to 1.5% and similar increases in body weight of approximately 3.0 kg. Pioglitazone significantly lowered triglyceride level (-40 mg/dL [-0.45 mmol/L]; 95% confidence interval [CI], -53 to -26 mg/dL [-0.60 to -0.29 mmol/L]), increased high-density lipoprotein cholesterol (HDL-C) level (+4.6 mg/dL [+0.12 mmol/L]; 95% CI, 3.6 to 5.5 mg/dL [0.09 to 0.14 mmol/L]), and showed neutral effect on low-density lipoprotein cholesterol (LDL-C) and total cholesterol levels. Rosiglitazone significantly increased HDL-C level (+2.7 mg/dL [+0.07 mmol/L]; 95% CI, 2.0 to 3.4 mg/dL [0.05 to 0.09 mmol/L]), but increased LDL-C level (+15 mg/dL [+0.39 mmol/L]; 95% CI, 13 to 17 mg/dL [0.34 to 0.44 mmol/L]), total cholesterol level (+21 mg/dL [+0.54 mmol/L]; 95% CI, 18 to 25 mg/dL [0.47 to 0.65 mmol/L]), and demonstrated neutral effect on triglyceride level (-1.1 mg/dL [-0.12 mmol/L]; 95% CI, -14 to 12 mg/dL [-0.16 to 0.14 mmol/L]). No data were available on pioglitazone and blood pressure. Rosiglitazone had a neutral effect on systolic (-0.7 mm Hg; 95% CI, -2.6 to 1.1 mm Hg) and diastolic (-0.8 mm Hg; 95% CI, -1.8 to 0.3) blood pressure.

CONCLUSIONS

Thiazolidinediones have similar effects on glycemic control and body weight. Pioglitazone produced a more favorable lipid profile. Head-to-head comparative trials as well as longer-term cardiovascular outcome studies are needed to determine whether there are differences in efficacy between the 2 thiazolidinediones.

Authors+Show Affiliations

University of Texas Health Science Center, San Antonio, TX 78229, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15505122

Citation

Chiquette, Elaine, et al. "A Meta-analysis Comparing the Effect of Thiazolidinediones On Cardiovascular Risk Factors." Archives of Internal Medicine, vol. 164, no. 19, 2004, pp. 2097-104.
Chiquette E, Ramirez G, Defronzo R. A meta-analysis comparing the effect of thiazolidinediones on cardiovascular risk factors. Arch Intern Med. 2004;164(19):2097-104.
Chiquette, E., Ramirez, G., & Defronzo, R. (2004). A meta-analysis comparing the effect of thiazolidinediones on cardiovascular risk factors. Archives of Internal Medicine, 164(19), pp. 2097-104.
Chiquette E, Ramirez G, Defronzo R. A Meta-analysis Comparing the Effect of Thiazolidinediones On Cardiovascular Risk Factors. Arch Intern Med. 2004 Oct 25;164(19):2097-104. PubMed PMID: 15505122.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A meta-analysis comparing the effect of thiazolidinediones on cardiovascular risk factors. AU - Chiquette,Elaine, AU - Ramirez,Gilbert, AU - Defronzo,Ralph, PY - 2004/10/27/pubmed PY - 2005/4/13/medline PY - 2004/10/27/entrez SP - 2097 EP - 104 JF - Archives of internal medicine JO - Arch. Intern. Med. VL - 164 IS - 19 N2 - BACKGROUND: In patients with type 2 diabetes mellitus, all therapeutic options should be evaluated for their effect on cardiovascular risk factors, in addition to glycemic control. We conducted a meta-analysis of randomized controlled trials of pioglitazone hydrochloride and rosiglitazone maleate in patients with type 2 diabetes to evaluate their effect on glycemic control, lipids, blood pressure, and weight. METHODS: Randomized controlled trials of patients with type 2 diabetes that compared pioglitazone or rosiglitazone with placebo for 12 weeks were included. Primary analysis was to compare thiazolidinediones with placebo. Secondary analysis was to identify whether treatment with pioglitazone differed from rosiglitazone in any outcomes. We calculated weighted mean differences and 95% confidence intervals. RESULTS: Twenty-three randomized controlled trials were identified. Both thiazolidinediones demonstrated similar hemoglobin A(1c) level decreases of 1.0% to 1.5% and similar increases in body weight of approximately 3.0 kg. Pioglitazone significantly lowered triglyceride level (-40 mg/dL [-0.45 mmol/L]; 95% confidence interval [CI], -53 to -26 mg/dL [-0.60 to -0.29 mmol/L]), increased high-density lipoprotein cholesterol (HDL-C) level (+4.6 mg/dL [+0.12 mmol/L]; 95% CI, 3.6 to 5.5 mg/dL [0.09 to 0.14 mmol/L]), and showed neutral effect on low-density lipoprotein cholesterol (LDL-C) and total cholesterol levels. Rosiglitazone significantly increased HDL-C level (+2.7 mg/dL [+0.07 mmol/L]; 95% CI, 2.0 to 3.4 mg/dL [0.05 to 0.09 mmol/L]), but increased LDL-C level (+15 mg/dL [+0.39 mmol/L]; 95% CI, 13 to 17 mg/dL [0.34 to 0.44 mmol/L]), total cholesterol level (+21 mg/dL [+0.54 mmol/L]; 95% CI, 18 to 25 mg/dL [0.47 to 0.65 mmol/L]), and demonstrated neutral effect on triglyceride level (-1.1 mg/dL [-0.12 mmol/L]; 95% CI, -14 to 12 mg/dL [-0.16 to 0.14 mmol/L]). No data were available on pioglitazone and blood pressure. Rosiglitazone had a neutral effect on systolic (-0.7 mm Hg; 95% CI, -2.6 to 1.1 mm Hg) and diastolic (-0.8 mm Hg; 95% CI, -1.8 to 0.3) blood pressure. CONCLUSIONS: Thiazolidinediones have similar effects on glycemic control and body weight. Pioglitazone produced a more favorable lipid profile. Head-to-head comparative trials as well as longer-term cardiovascular outcome studies are needed to determine whether there are differences in efficacy between the 2 thiazolidinediones. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/15505122/A_meta_analysis_comparing_the_effect_of_thiazolidinediones_on_cardiovascular_risk_factors_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinte.164.19.2097 DB - PRIME DP - Unbound Medicine ER -