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