Weighing up the cardiovascular benefits of thiazolidinedione therapy: the impact of increased risk of heart failure

被引:57
作者
Erdmann, Erland [1 ]
Wilcox, Robert G. [2 ]
机构
[1] Univ Cologne, Dept Cardiol, D-50937 Cologne, Germany
[2] Univ Nottingham Hosp, Nottingham NG7 2UH, England
关键词
heart failure; oedema; pioglitazone; rosiglitazone; thiazolidinediones; type; 2; diabetes;
D O I
10.1093/eurheartj/ehm529
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Type 2 diabetes and heart failure commonly occur together and this combination is associated with poor outcomes. The relationship is likely to be multifactorial and also may involve a specific, though ill-defined, diabetic cardiomyopathy. Glucose-lowering therapies may also be associated with an increased risk of heart failure. Data from recent large-scale clinical trials have drawn particular attention to the thiazolidinediones that appear to increase the risk of heart failure in patients with type 2 diabetes. Although pioglitazone therapy has been shown to decrease the risk of macrovascular events, the overall cardiovascular benefit needs to be addressed together with the apparent increase in heart failure risk. In this review, we provide appropriate context for assessing this balance from several perspectives. First, we consider the high underlying risk of heart failure already present in type 2 diabetes. Secondly, we highlight a potential distinction between genuine heart failure due to cardiac dysfunction and thiazolidinedione-associated oedema that may simply unmask previously undiagnosed cardiac dysfunction without itself having any direct impact on heart muscle. Most importantly, we emphasize the apparent lack of any long-term mortality consequences and a relative improvement in outcomes associated with thiazolidinedione-induced 'heart failure' and discuss the potential mechanisms underlying this apparent paradox. Finally, we review the current guidelines for thiazolidinedione use and heart failure and suggest potential future strategies for avoiding and/or minimizing this association.
引用
收藏
页码:12 / 20
页数:9
相关论文
共 74 条
[61]   Thiazolidinediones and heart failure - A teleo-analysis [J].
Singh, Sonal ;
Loke, Yoon K. ;
Furberg, Curt D. .
DIABETES CARE, 2007, 30 (08) :2148-2153
[62]   Thiazolidinediones and congestive heart failure - exacerbation or new onset of left ventricular dysfunction? [J].
Srivastava, PM ;
Calafiore, P ;
MacIsaac, RJ ;
Hare, DL ;
Jerums, G ;
Burrell, LM .
DIABETIC MEDICINE, 2004, 21 (08) :945-950
[63]   A comparison of the effects of rosiglitazone and glyburide on cardiovascular function and glycemic control in patients with type 2 diabetes [J].
Sutton, MS ;
Rendell, M ;
Dandona, P ;
Dole, JF ;
Murphy, K ;
Patwardhan, R ;
Patel, J ;
Freed, M .
DIABETES CARE, 2002, 25 (11) :2058-2064
[64]  
*TAK PHARM CO LIM, 2007, ACT PIOGL HYDR
[65]   Do thiazolidinediones cause heart failure? A critical review [J].
Tang, WHW .
CLEVELAND CLINIC JOURNAL OF MEDICINE, 2006, 73 (04) :390-397
[66]   Fluid retention after initiation of thiazolidinedione therapy in diabetic patients with established chronic heart failure [J].
Tang, WHW ;
Francis, GS ;
Hoogwerf, BJ ;
Young, JB .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2003, 41 (08) :1394-1398
[67]   The association between glucose abnormalities and heart failure in the population-based Reykjavik study [J].
Thrainsdottir, IS ;
Aspelund, T ;
Thorgeirsson, G ;
Gudnason, V ;
Hardarson, T ;
Malmberg, K ;
Sigurdsson, G ;
Rydén, L .
DIABETES CARE, 2005, 28 (03) :612-616
[68]   Pioglitazone improves left ventricular diastolic function and decreases collagen accumulation in prediabetic stage of a type II diabetic rat [J].
Tsuji, T ;
Mizushige, K ;
Noma, T ;
Murakami, K ;
Ohmori, K ;
Miyatake, A ;
Kohno, M .
JOURNAL OF CARDIOVASCULAR PHARMACOLOGY, 2001, 38 (06) :868-874
[69]   Influence of diabetes on the survival of patients hospitalized with heart failure: A 12-year study [J].
Varela-Roman, A ;
Shamagian, LG ;
Caballero, EB ;
Ramos, PM ;
Veloso, PR ;
Gonzalez-Juanatey, JR .
EUROPEAN JOURNAL OF HEART FAILURE, 2005, 7 (05) :859-864
[70]   Effects of pioglitazone in patients with type 2 diabetes with or without previous stroke - Results from PROactive (PROspective pioglitAzone Clinical Trial in macroVascular Events 04) [J].
Wilcox, Robert ;
Bousser, Marie-Germaine ;
Betteridge, D. John ;
Schernthaner, Guntram ;
Pirags, Valdis ;
Kupfer, Stuart ;
Dormandy, John .
STROKE, 2007, 38 (03) :865-873