{"title":"Reassessing the Risk-Benefit Profile of Thiazolidinediones: Cardiovascular Risks and Stroke Prevention Through Real-World Data.","authors":"Lu Fei, Yingjie Zhao","doi":"10.1016/j.eprac.2025.04.004","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Research has increasingly explored the benefits of thiazolidinediones (TZDs) beyond diabetes management, particularly in reducing stroke and dementia risks. However, concerns about cardiovascular adverse events, especially heart failure (HF), necessitate a re-evaluation of TZD-associated cardiovascular risks using real-world data.</p><p><strong>Methods: </strong>This study re-evaluates the cardiovascular risks of TZDs and their efficacy in stroke prevention. We conducted a real-world pharmacovigilance study using the US Food and Drug Administration Adverse Event Reporting System (FAERS) database (January 2004 to December 2023) to assess cardiovascular risks associated with TZDs, including myocardial infarction, HF, and stroke. Multivariable logistic regression adjusted the reporting odds ratio from the disproportional analysis. Additionally, a network meta-analysis of clinical studies (January 2000 to March 2024) examined the efficacy of TZDs in stroke prevention.</p><p><strong>Results: </strong>Our analysis of the FAERS database revealed significantly higher cardiovascular risks associated with TZDs. However, clear differences exist in cardiovascular risks between pioglitazone and rosiglitazone. Rosiglitazone was linked to a markedly increased incidence of myocardial infarction, HF, and stroke. In contrast, we didn't observe strong cardiovascular risks associated with pioglitazone. Instead, pioglitazone was shown to slightly heighten the risk of HF. Further, the network meta-analysis, based on SUCRA rankings and ranking probabilities also disclosed similar findings: when compared to placebo, rosiglitazone increased stroke risk, while pioglitazone reduced stroke incidence in individuals with diabetes and prediabetes.</p><p><strong>Conclusions: </strong>Our analysis shows that pioglitazone has potential therapeutic effects on stroke prevention and fewer cardiovascular adverse events compared to rosiglitazone, underscoring the importance of reassessing TZD safety for optimal patient outcomes.</p>","PeriodicalId":11682,"journal":{"name":"Endocrine Practice","volume":" ","pages":""},"PeriodicalIF":3.7000,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Endocrine Practice","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.eprac.2025.04.004","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives: Research has increasingly explored the benefits of thiazolidinediones (TZDs) beyond diabetes management, particularly in reducing stroke and dementia risks. However, concerns about cardiovascular adverse events, especially heart failure (HF), necessitate a re-evaluation of TZD-associated cardiovascular risks using real-world data.
Methods: This study re-evaluates the cardiovascular risks of TZDs and their efficacy in stroke prevention. We conducted a real-world pharmacovigilance study using the US Food and Drug Administration Adverse Event Reporting System (FAERS) database (January 2004 to December 2023) to assess cardiovascular risks associated with TZDs, including myocardial infarction, HF, and stroke. Multivariable logistic regression adjusted the reporting odds ratio from the disproportional analysis. Additionally, a network meta-analysis of clinical studies (January 2000 to March 2024) examined the efficacy of TZDs in stroke prevention.
Results: Our analysis of the FAERS database revealed significantly higher cardiovascular risks associated with TZDs. However, clear differences exist in cardiovascular risks between pioglitazone and rosiglitazone. Rosiglitazone was linked to a markedly increased incidence of myocardial infarction, HF, and stroke. In contrast, we didn't observe strong cardiovascular risks associated with pioglitazone. Instead, pioglitazone was shown to slightly heighten the risk of HF. Further, the network meta-analysis, based on SUCRA rankings and ranking probabilities also disclosed similar findings: when compared to placebo, rosiglitazone increased stroke risk, while pioglitazone reduced stroke incidence in individuals with diabetes and prediabetes.
Conclusions: Our analysis shows that pioglitazone has potential therapeutic effects on stroke prevention and fewer cardiovascular adverse events compared to rosiglitazone, underscoring the importance of reassessing TZD safety for optimal patient outcomes.
期刊介绍：
Endocrine Practice (ISSN: 1530-891X), a peer-reviewed journal published twelve times a year, is the official journal of the American Association of Clinical Endocrinologists (AACE). The primary mission of Endocrine Practice is to enhance the health care of patients with endocrine diseases through continuing education of practicing endocrinologists.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
