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Thiazolidinediones do not lower AF incidence in patients with diabetes, coronary disease

12 Jul 2018
Studies have shown that in general, about 40% of patients are non-adherent to their medication.

Use of thiazolidinediones does not lead to a significant reduction in incidence of atrial fibrillation (AF) among patients with diabetes and coronary disease, a recent study has found.

Of the 2,319 patients enrolled in the study, 1,160 were assigned to the insulin-sensitization strategy and 1,159 to the insulin-provision strategy. A total of 90 patients (3.9 percent) developed new-onset AF during a median follow-up of 4.2 years.

The intention-to-treat analysis demonstrated an AF incidence of 8.7 per 1,000 person-years in patients assigned to insulin sensitization vs 9.5 in those assigned to insulin provision (hazard ratio [HR], 0.91; 95 percent CI, 0.60–1.38; p=0.66).

On the other hand, the incidence rate per 1,000 person-years in a time-varying exposure analysis was 7.2 for patients exposed to thiazolidinediones and 9.7 for those who were not (adjusted HR, 0.80; 0.33–1.94; p=0.62). The HR in a subset of patients matched on propensity to receive thiazolidinediones was 0.75 (0.43–1.30; p=0.30).

A 2008 study showed that the glycaemic efficacy of thiazolidinediones and metformin were similar, but adverse effects and higher costs made the former less appealing for initial therapy. [Ann Pharmacother 2008;42:1466-1474]

To examine whether insulin-sensitizing therapy (thiazolidinediones or metformin) reduced the risk of developing AF vs insulin-providing therapy (insulin, sulphonylurea or meglitinide), the authors enrolled patients with type 2 diabetes and documented coronary artery disease. All patients were randomly assigned to insulin-sensitizing or insulin-providing therapy.

“Thiazolidinediones are insulin sensitizers that also decrease the inflammatory response,” the authors said. “Because inflammation is a risk factor for AF, we hypothesized that treating diabetes with thiazolidinediones might decrease the risk of developing AF.”

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Most Read Articles
Prof. Cheuk-Chun Szeto, Dr. Winston W. S. Fung, 25 Jan 2018
A 65-year-old lady with a background of type 2 diabetes, hyperlipidaemia and chronic immune thrombocytopenia presented to us with a 2-week history of generalized malaise and myalgia. Shortly after the onset of myalgia, she was noted to have reduced urine output and the urine was described as dark in colour. Her regular medications included prednisolone, danazol, simvastatin, metformin, and human insulin. Upon further questioning, the patient admitted that her compliance to simvastatin and danazol used to be poor. However, she recently started to take both medications regularly after repeated education.
26 Dec 2017
Supplementation with omega-3 fatty acids in combination with rosuvastatin may yield significant reductions in triglycerides and nonhigh-density lipoprotein (HDL) cholesterol as compared with rosuvastatin monotherapy, according to data from the ROMANTIC (rosuvastatin-omacor in residual hypertriglyceridemia) trial.
Jairia Dela Cruz, 26 Jun 2018
The monoclonal antibody denosumab is safe and effective for use in patients on glucocorticoids and at risk of developing fractures, with a recent study showing that the drug performs better than risedronate in increasing bone mineral density (BMD).
Pearl Toh, 20 Mar 2018
Not only does treatment with the PCSK9* inhibitor alirocumab reduces cardiovascular (CV) events along with plunges in LDL-C levels, it was also associated with a reduced risk of all-cause mortality compared with placebo in patient with a recent acute coronary syndrome (ACS) and persistently high cholesterol despite maximal statin therapy, according to top-line results from the ODYSSEY** Outcomes trial.