Rosiglitazone linked to increased risk of stroke

A new study has found that among patients aged 65 years or older, rosiglitazone is associated with an increased risk of stroke, heart failure and all-cause mortality when compared with pioglitazone.

According to the authors, previous studies “ suggested that the use of rosiglitazone may be associated with an increased risk of serious cardiovascular events compared with other treatments for type II diabetes”.

Doctors evaluated data from 227,571 patients whose average age was 74.4 years and who were treated with rosiglitazone or pioglitazone. The patients were followed for up to three years after the initiation of the medications.

“During follow-up, there were 1,746 acute myocardial infarctions (21.7 per cent fatal), 1,052 strokes (7.3 per cent fatal), 3,307 hospitalizations for heart failure (2.6 per cent fatal), and 2,562 deaths for all causes among cohort members,” the study’s authors reported.
Analysis showed no differences in the risk for heart attack between rosiglitazone and pioglitazone. However, the researchers reported that the study “found that rosiglitazone was associated with a 1.25-fold increase in risk of heart failure compared with pioglitazone”.

According to the researchers, such findings “suggest that rosiglitazone was associated with a 1.27-fold increased risk of stroke and a 1.14-fold increased risk of death compared with pioglitazone”.

In an accompanying editorial, David Juurlink, MD, PhD, of the University of Toronto and Institute for Clinical Evaluative Sciences, said the study highlights the importance of understanding the risks of rosiglitazone.

“The epilogue of the rosiglitazone story has yet to be written, but a few observations can now be made with confidence,” Dr Juurlink wrote.

“First, there is no direct evidence that rosiglitazone prevents vascular events in patients with diabetes. Second, converging lines of evidence suggest that rosiglitazone is less safe than pioglitazone, whereas no data suggest that the converse might be true. Third, because the evidence to date is not conclusive, differing views have emerged on how to proceed in the face of uncertainty.”

Early online version of JAMA, available at www.jamamedia.org