TY - JOUR
T1 - Pioglitazone and cardiovascular outcomes in patients with insulin resistance, pre-diabetes and type 2 diabetes
T2 - A systematic review and meta-analysis
AU - Liao, Hung Wei
AU - Saver, Jeffrey L.
AU - Wu, Yi Ling
AU - Chen, Tso Hsiao
AU - Lee, Meng
AU - Ovbiagele, Bruce
N1 - Funding Information:
This work was supported by Ministry of Science and Technology, Taiwan, grant number: MOST104-2314-B-182-019 and MOST105-2628-B-182-008-MY2.
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Objectives: To evaluate the effect of pioglitazone in people with insulin resistance, pre-diabetes and type 2 diabetes. Design and setting: Systematic review and metaanalysis 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.
AB - Objectives: To evaluate the effect of pioglitazone in people with insulin resistance, pre-diabetes and type 2 diabetes. Design and setting: Systematic review and metaanalysis 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.
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U2 - 10.1136/bmjopen-2016-013927
DO - 10.1136/bmjopen-2016-013927
M3 - Review article
C2 - 28057658
AN - SCOPUS:85009136703
SN - 2044-6055
VL - 7
JO - BMJ Open
JF - BMJ Open
IS - 1
M1 - e013927
ER -