Format

Send to

Choose Destination
BMJ Open. 2017 Jan 5;7(1):e013927. doi: 10.1136/bmjopen-2016-013927.

Pioglitazone and cardiovascular outcomes in patients with insulin resistance, pre-diabetes and type 2 diabetes: a systematic review and meta-analysis.

Author information

1
Jia-Yi Clinic, Taoyuan, Taiwan.
2
UCLA Stroke Center, Los Angeles, California, USA.
3
Department of Neurology, Research Services Center for Health Information, Chang Gung University, Taoyuan, Taiwan.
4
Department of Nephrology, School of Medicine, College of Medicine, Taipei Medical University, Wan Fang Hospital, Taipei, Taiwan.
5
Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.
6
Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA.

Abstract

OBJECTIVES:

To evaluate the effect of pioglitazone in people with insulin resistance, pre-diabetes and type 2 diabetes.

DESIGN AND SETTING:

Systematic review and meta-analysis of randomised, controlled trials.

DATA SOURCES:

Literature searches were performed across PubMed, EMBASE, MEDLINE and Cochrane Central Register of Controlled Trials from 1966 to May 2016 to identify randomised, controlled trials with more than 1 year follow-up.

OUTCOME MEASURES:

Relative risk (RR) with 95% CI was used to evaluate the association between pioglitazone and the risk of major adverse cardiovascular events (MACE: composite of non-fatal myocardial infarction, non-fatal stroke and cardiovascular death) and safety outcomes, after pooling data across trials in a fixed-effects model.

RESULTS:

Nine trials with 12 026 participants were enrolled in the current meta-analysis. Pioglitazone therapy was associated with a lower risk of MACE in patients with pre-diabetes or insulin resistance (RR 0.77, 95% CI 0.64 to 0.93), and diabetes (RR 0.83, 95% CI 0.72 to 0.97). Risks of heart failure (RR 1.32; CI 1.14 to 1.54), bone fracture (RR 1.52, 95% CI 1.17 to 1.99), oedema (RR, 1.63; CI 1.52 to 1.75) and weight gain (RR 1.60; CI 1.50 to 1.72) increased in pioglitazone group.

CONCLUSIONS:

Pioglitazone was associated with reduced risk of MACE in people with insulin resistance, pre-diabetes and diabetes mellitus. However, the risks of heart failure, bone fracture, oedema and weight gain were increased.

PMID:
28057658
PMCID:
PMC5223642
DOI:
10.1136/bmjopen-2016-013927
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for HighWire Icon for PubMed Central
Loading ...
Support Center