Use of thiazolidinediones and risk of hospitalization for myocardial infarction with type 2 diabetes

• Main Authors: Shu-Ting Chan, 詹婌婷
• Other Authors: Weng-Foung Huang
• Format: Others
• Language: zh-TW
• Published: 2009
• Online Access: http://ndltd.ncl.edu.tw/handle/30436748322885484311

碩士 === 國立陽明大學 === 衛生福利研究所 === 97 === Background: Thiazolidinediones (TZDs) are new class of oral antidiabetic agents, however, recent studies have raised concerns over the increased cardiovascular (CV) risk of TZDs in type 2 diabetic patients. Aim: To assess the risk of myocardial infarction (MI) in type 2 diabetic patients exposed to pioglitazone and rosiglitazone respectively compared to other oral antidiabetic agents. Methods: We conducted a retrospective cohort study using claims database of Taiwan’s National Health Insurance (NHI) between 2001~2005. The study subjects were newly diagnosed type 2 diabetic patients. We first classified our study subjects based on their initial treatments (metformin or sulfonylurea). In metformin group, the study subjects were grouped into those who received add-on pioglitazone (1,339), add-on rosiglitazone users (4,396) and non-TZD users (41,819). In sulfonylurea group, the study subjects were grouped into those who received add-on pioglitazone (4,361), add-on rosiglitazone users (4,361) and non-TZD users (126,579). We used Cox’s proportional hazard model to estimate the hazard ratio (HR) of incident hospitalization for MI after add-on treatment of rosiglitzone or pioglitazone . Results: Among sulfonylurea group, the crude rates per 100,000 person days for the outcome (hospitalization for MI) in patients who received add-on pioglitazone or rosiglitazone were 1.23 and 1.53, respectively. In metformin group, the crude rates per 100,000 person days for the outcome (hospitalization for MI) in patients who received add-on pioglitazone or rosiglitazone were 1.23 and 1.53, respectively. In sulfonylurea group, among the patients who received add-on pioglitazone or rosiglitazone versus non-TZD, the lower HR for hospitalization for MI were 0.515 (CI=0.347-0.763) and 0.596 (CI=0.505-0.703), respectively. In metformin group, the HR for hospitalization for MI were 0.54 (CI=0.253-1.152) and 0.528 (CI=0.360-0.773), respectively. The subgroup that received additional second oral antidiabetic agents for less than 12 months had lower HR of hospitalization for MI. Conclusions: Our study suggests that those who received add-on TZDs in comparison to non-TZDs users had reduced hazard of hospitalization for MI in patients with type 2 diabetes mellitus.