My Diabetes Information Blogs
Pioglitazone Reduced Heart Attack, Increased Heat Failure
09/11/07
Diabetes Medications, Prediabetes and Impaired Glucose Tolerance, Type II Diabetes, Treatment Options, Prevention, General
CHICAGO – It is hard to know which medications to use to lower blood glucose levels. Beside their potency as anti-diabetes medications, diabetics must also consider side effects. Many of them are potentially serious.
A study combining previous research suggests that use of pioglitazone, marketed as brand name Actos, significantly reduces the risk of heart attack, stroke, and death, but increases the risk for serious heart failure, according to an article in the September 12 issue of JAMA. The risk of heart failure is low, while the reduction in heart attack rate is high. As a result, we suspect that many doctors will be migrating their patients to Actos (brand name for pioglitazone).
A. Michael Lincoff, M.D., and colleagues at the Cleveland Clinic, brought together the statistics from a number of studies to evaluate the effect of pioglitazone on the incidence of cardiovascular complications related to inadequate blood supply for patients with type 2 diabetes. This analysis came from 19 other studies and 16,390 patients. Duration of pioglitazone use ranged from 4 months to 3.5 years.
The researchers found that heart attack, stroke, or death occurred in 375 (4.4 percent) of 8,554 patients receiving pioglitazone and 450 (5.7 percent) of 7,836 patients treated with control therapy, an 18 percent relative reduction. These outcomes were all reduced by a similar magnitude with pioglitazone treatment. Serious heart failure was reported in 200 (2.3 percent) of pioglitazone-treated patients and 139 (1.8 percent) of control patients.
“These findings suggest that the net clinical cardiovascular benefit with pioglitazone therapy is favorable, with an important reduction in irreversible ischemic events that is not attenuated by the risk of more frequent heart failure complications,” the authors write.
In other words, in spite of the slight increased heart failure risk, pioglitazone is still a good medication choice because of its ability to reduce heart attacks by improving blood flow to the heart. The increased risk of heart failure is smaller than the 18 percent benefit of reducing heart attacks.
Pioglitazone is also an ingredient in ActoPLUSMet (pioglitazone and metformin) and Duetact (pioglitazone and glimepiride).
Source: JAMA. 2007;298(10):1180-1188