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Thiazolidinediones May Cut Myocardial Infarction Risk in Type 2 Diabetics: Presented at AHA

By Jill Stein

CHICAGO, IL -- November 20, 2002 -- The use of thiazolidinediones as a strategy for blood glucose lowering in type 2 diabetics may be associated with a reduced risk of myocardial infarction (MI).

The findings were presented by Dr. William H. Sauer and co-workers at the University of Pennsylvania School of Medicine in Philadelphia, Pennsylvania, United States, at the 2002 Scientific Sessions of the American Heart Association (AHA).

The researchers conducted a case-control study of myocardial infarction (MI) in the Philadelphia metropolitan area to examine the effects of prescription and over-the-counter drug exposure and the risk of MI. Cases were type 2 diabetics aged 40 through 75 with a first MI who were hospitalized at one of 36 acute care hospitals from May, 1998 through April, 2001 in a five- county region. Controls were subjects meeting the same above inclusion and exclusion criteria, and they were selected using random digit dialing.

Detailed information regarding medication use and other clinical and demographic data were obtained by telephone interview. There were 50 thiazolidinedione users among 462 type 2 diabetics.

After adjustment for all confounders including age, sex, race, beta-blocker or insulin use, and a history of hypertension or hypercholesterolemia, the odds ratio for MI among current thiazolidinedione users compared with other diabetics was 0.40 (< 0.01). There was no significant association between MI risk and the use of insulin, metformin, sulfonylurea, or other hypoglycemic drug use.

Dr. Sauer said that the results are consistent with the previously observed association between metformin use and reduced risk of MI, suggesting that insulin sensitization is the mechanism for the prevention of macrovascular complications of diabetes.

Recall bias is unlikely because there was no association observed between users of other hypoglycemic agent (who would be expected to have the same bias) and MI prevention.

The potential benefit of thiazolidinediones over diet or other specific oral hypoglycemic drugs could not be assessed because there were too few subjects who used thiazolidinediones as a single agent.

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