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Rosiglitazone in new heart risk finding

Cardiac problems are increased with rosiglitazone – but not pioglitazone – suggest two new meta-analyses.

Analysis of trials of rosiglitazone found a 42% increased risk of heart attack and double the risk of heart failure but without a significant increase in cardiovascular deaths.

A separate study of 19 trials found that pioglitazone is associated with a significantly lower risk of death, myocardial infarction or stroke in patients with diabetes.

Serious heart failure was found to be increased by pioglitazone, although without an associated increase in mortality.

Both studies in JAMA come just a few weeks after the US Food and Drug Administration ordered a ‘boxed' warning about the risk of heart failure to be placed on all glitazones.

But in June this year, early findings from a major international trial suggested rosiglitazone did not increase cardiovascular risk after all and may have been written off too quickly.

However, the authors of the latest rosiglitazone paper were clear, saying: ‘These data suggest a reversal of the benefit-to-harm balance for rosiglitazone present at the time of approval.

‘Currently there appear to be much safer treatment alternatives. Physicians should not wait for regulatory actions. They should avoid using rosiglitazone in patients with diabetes who are at risk of cardiovascular events.'

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