Using population-based health care databases from Ontario, the authors conducted a nested case-control analysis to explore the association between thiazolidinediones (TZDs) and congestive heart failure, acute myocardial infarction, and mortality compared to treatment with other oral hypoglycemic agents. Among the 159,026 patients with oral hypoglycemic agent-treated diabetes followed for 3.8 years, 12,491 patients (7.9%) were hospitalized for congestive heart failure, 12,578 (7.9%) for acute myocardial infarction, and 30,265 (19%) died. The authors found that TZD treatment significantly increased the risk of congestive heart failure, acute myocardial infarction, and all-cause mortality among older patients with diabetes compared to other oral diabetes treatments. Moreover, the increased risk associated with TZDs remained significant even after adjustment for a number of important prognostic factors and was independent of baseline cardiovascular risk or diabetes duration. The authors also noted that the incremental risk associated with TZD treatment appears to be limited to rosiglitazone. The authors conclude that TZD treatment, especially with rosiglitazone, may outweigh its benefits, even in patients without previous cardiovascular disease. Therefore, they underline the importance of evaluating the potential benefits and harms of TZD treatment before prescribing diabetes treatment to patients, especially among high-risk elderly populations.
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