Relationship of Glycemia to Cardiovascular Disease ... - Lipids Online
Relationship of Glycemia to Cardiovascular Disease ... - Lipids Online
Relationship of Glycemia to Cardiovascular Disease ... - Lipids Online
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Risk <strong>of</strong> Congestive Heart Failure and <strong>Cardiovascular</strong><br />
Death With Thiazolidinediones<br />
Risk <strong>of</strong> CHF<br />
ADOPT (RSG)<br />
Dargie et al. (RSG)<br />
Mazzone et al. (Pio)<br />
DREAM (RSG)<br />
PPAR (RSG)<br />
PROactive (Pio)<br />
RECORD (RSG)<br />
TOTAL<br />
Risk <strong>of</strong> CHF<br />
ADOPT (RSG)<br />
Dargie et al. (RSG)<br />
Mazzone et al. (Pio)<br />
DREAM (RSG)<br />
PPAR (RSG)<br />
PROactive (Pio)<br />
RECORD (RSG)<br />
TOTAL<br />
Risk Ratio (95% Confidence Interval)<br />
Decreased Risk Increased Risk<br />
0.1 0.2 0.5 1 2 5 10<br />
Risk Ratio (95% Confidence Interval)<br />
Decreased Risk Increased Risk<br />
0.1 0.2 0.5 1 2 5 10<br />
Weight<br />
12.0%<br />
7.3%<br />
1.1%<br />
5.0%<br />
1.2%<br />
49.0%<br />
23.5%<br />
100.0%<br />
Weight<br />
9.8%<br />
6.4%<br />
1.4%<br />
15.2%<br />
1.9%<br />
20.9%<br />
44.5%<br />
100.0%<br />
Risk Ratio (95% CI)<br />
1.49 (0.62, 3.53)<br />
1.81 (0.55, 6.02)<br />
2.97 (0.12, 72.63)<br />
7.00 (1.59, 30.76)<br />
2.88 (0.12, 69.94)<br />
1.31 (1.03, 1.67)<br />
2.24 (1.27, 3.96)<br />
1.72 (1.21, 2.42)<br />
Test for overall effect: p = 0.002<br />
Risk Ratio (95% CI)<br />
0.83 (0.29, 2.35)<br />
1.30 (0.36, 4.07)<br />
0.99 (0.06, 15.75)<br />
1.20 (0.52, 2.77)<br />
0.48 (0.04, 5.21)<br />
1.01 (0.50, 2.06)<br />
0.83 (0.51, 1.35)<br />
0.93 (0.67, 1.29)<br />
Test for overall effect: p = 0.068<br />
Reprinted from Lago RM, et al. Lancet. 2007;<br />
370:1129–1136, with permission from Elsevier.<br />
Slide Source<br />
<strong>Lipids</strong> <strong>Online</strong> Slide Library<br />
www.lipidsonline.org<br />
Risk <strong>of</strong> Congestive Heart Failure and <strong>Cardiovascular</strong> Death With<br />
Thiazolidinediones<br />
A meta-analysis by Lago et al. (2007) examined randomized clinical trials in which<br />
cardiovascular (CV) events were either endpoints or were adjudicated by an expert panel.<br />
These investiga<strong>to</strong>rs found that there was no excess risk <strong>of</strong> CV-related death when<br />
thiazolidinediones were compared <strong>to</strong> other treatments and when rosiglitazone was<br />
compared <strong>to</strong> pioglitazone.<br />
Reference:<br />
Lago RM, Singh PP, Nes<strong>to</strong> RW. Congestive heart failure and cardiovascular death in<br />
patients with prediabetes and type 2 diabetes given thiazolidinediones: a meta-analysis <strong>of</strong><br />
randomised clinical trials. Lancet. 2007;370:1129-1136.<br />
Annual Incidence <strong>of</strong> Congestive Heart Failure in<br />
Randomized Clinical Trials <strong>of</strong> PPAR- Agonists<br />
Trial<br />
<strong>Disease</strong><br />
N<br />
Diagnosed CHF<br />
TZD<br />
Compara<strong>to</strong>r<br />
DREAM<br />
IFG /IGT<br />
5269<br />
Adjudicated<br />
RSG 0.18%<br />
Placebo 0.03%<br />
ADOPT<br />
T2DM<br />
4351<br />
Adverse events<br />
RSG 0.21%<br />
SU 0.5%<br />
Metformin 0.21%<br />
RECORD<br />
T2DM<br />
4447<br />
Hospital CHF,<br />
adjudicated, and<br />
pending<br />
RSG 0.56%<br />
Metformin / SU<br />
0.26%<br />
CHICAGO<br />
T2DM<br />
462<br />
Adjudicated CHF<br />
Pio 0.62%<br />
SU (0)<br />
PPAR<br />
Metabolic Syndrome<br />
CAD + PCI<br />
200<br />
Adjudicated CHF<br />
RSG 1.2%<br />
Placebo (0)<br />
PROactive<br />
T2DM / CVD<br />
5238<br />
Hospitalized<br />
Pio 2.0%<br />
Placebo 1.4%<br />
PROactive<br />
T2DM / CVD Status<br />
Post MI<br />
2445<br />
Hospitalized<br />
Pio 2.6%<br />
Placebo 1.8%<br />
Dargie et al.<br />
T2DM / NYHA I/II CHF<br />
224<br />
Adjudicated CHF<br />
RSG 6.3%<br />
Placebo 3.5%<br />
CAD = coronary artery disease; CHF= congestive heart failure; CVD = cardiovascular disease; IFG =<br />
impaired fasting glucose; IGT = impaired glucose <strong>to</strong>lerance; MI = myocardial infarction; NYHA = New<br />
York Heart Association; PCI = percutaneous coronary intervention; Pio = pioglitazone; PPAR =<br />
peroxisome prolifera<strong>to</strong>r-activated recep<strong>to</strong>r; RSG = rosiglitazone; SU = sulfonylurea; T2DM = type 2<br />
diabetes mellitus; TZD = thiazolidinedione<br />
Slide Source<br />
<strong>Lipids</strong> <strong>Online</strong> Slide Library<br />
www.lipidsonline.org<br />
Source: <strong>Lipids</strong> <strong>Online</strong> Slide Library (www.lipidsonline.org) Page 20 <strong>of</strong> 36<br />
© 2009 Baylor College <strong>of</strong> Medicine, Hous<strong>to</strong>n, Texas
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