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- May 17, 2008 |
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"Thiazolidinediones and the Heart: A Tale of Two Organs?"Dr. Robin Buckingham (biography)
English - 2006-03-27 - 58 minutes
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Summary :
In this presentation Dr. Buckingham talks about congestive heart failure (CHF) and diabetes in general and in the context of thiazolidinedione treatment.
Are the perceived cardiovascular benefits of thiazolidinediones negated by an increased incidence of CHF? First looking at some background data, in a 6-year cohort study from Kaiser Permanente, risk factors for incident CHF were found to be age at baseline, duration of diabetes, BMI, poor glycemic and blood pressure control, diabetic complications including nephropathy and ischemic heart disease, and treatment with insulin (1). In a Swedish community-based sample of elderly men, insulin resistance itself was found to be a predictor of CHF incidence independently of established risk factors including diabetes (2). Patients with diabetes and heart failure also have shorter survival times than their nondiabetic counterparts (3). The PROactive study and others have raised concerns about increased rates of heart failure associated with thiazolidinedione treatment. Dr. Buckingham reviews these findings and their interpretation taking into account study limitations and characteristics of the patients studied (4,5).
Thiazolidinedione treatment has also been associated with lower incidence rates of CHF compared to insulin (6,7) , and cohort studies have shown reduced one-year mortality rates due to thiazolidinedione and/or metformin treatment in patients with diabetes and heart failure (8) or acute myocardial infarction (9). What mechanisms might underpin apparent thiazolidinedione benefits in patients with CHF? Dr. Buckingham discusses beneficial effects on the heart including improved cardiac energy metabolism in patients with type 2 diabetes (10,11).
Dr. Buckingham also talks about the mechanisms of fluid retention associated with thiazolidinedione use, risk factors for heart failure in patients treated with thiazolidinediones, and recommended steps that clinicians can take when faced with signs or symptoms of CHF (12).
Copyright © 2006 E-MedHosting.com Inc.
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Risk factors for incident CHF
- Thiazolidinediones and other treatments in relation to CHF incidence
- Effects of thiazolidinediones on cardiac energy metabolism in type 2 diabetes
- Risk factors for heart failure in patients treated with thiazolidinediones
- Clinical practice recommendations
Bibliographic references :
1. Gregory A. Nichols, PHD, Christina M. Gullion, PHD, Carol E. Koro, PHD, Sara A. Ephross, PHD and Jonathan B. Brown, PHD, MPP The Incidence of Congestive Heart Failure in Type 2 Diabetes: An update Diabetes Care 27:1879-1884, 2004.
2. Ingelsson E, Sundstrom J, Arnlov J, Zethelius B, Lind L.Insulin resistance and risk of congestive heart failure. JAMA. 2005 Jul 20;294(3):334-41.
3. Varela-Roman A, Grigorian Shamagian L, Barge Caballero E, Mazon Ramos P, Rigueiro Veloso P, Gonzalez-Juanatey JR.Influence of diabetes on the survival of patients hospitalized with heart failure: A 12-year study Eur J Heart Fail. 2005 Aug;7(5):859-64.
4. Dormandy JA, Charbonnel B, Eckland DJ, Erdmann E, Massi-Benedetti M, Moules IK, Skene AM, Tan MH, Lefebvre PJ, Murray GD, Standl E, Wilcox RG, Wilhelmsen L, Betteridge J, Birkeland K, Golay A, Heine RJ, Koranyi L, Laakso M, Mokan M, Norkus A, Pirags V, Podar T, Scheen A, Scherbaum W, Schernthaner G, Schmitz O, Skrha J, Smith U, Taton J; PROactive investigators.Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macroVascular Events): a randomised controlled trial Lancet. 2005 Oct 8;366(9493):1279-89.
5. Delea TE, Edelsberg JS, Hagiwara M, Oster G, Phillips LS.Use of Thiazolidinediones and Risk of Heart Failure in People With Type 2 Diabetes Diabetes Care 26:2983-2989, 2003.
6. Rajagopalan R, Rosenson RS, Fernandes AW, Khan M, Murray FT.Association between congestive heart failure and hospitalization in patients with type 2 diabetes mellitus receiving treatment with insulin or pioglitazone: a retrospective data analysis Clin Ther. 2004 Sep;26(9):1400-10.
7. A. J. Karter, A. T. Ahmed, J. Liu, H. H. Moffet and M. M. ParkerPioglitazone initiation and subsequent hospitalization for congestive heart failure Diabet Med. 2005 Aug;22(8):986-93.
8. Frederick A. Masoudi, MD, MSPH; Silvio E. Inzucchi, MD; Yongfei Wang, MS; Edward P. Havranek, MD; JoAnne M. Foody, MD; Harlan M. Krumholz, MDThiazolidinediones, Metformin, and Outcomes in Older Patients With Diabetes and Heart Failure: An Observational Study Circulation. 2005;111:583-590.
9. Inzucchi SE, Masoudi FA, Wang Y, Kosiborod M, Foody JM, Setaro JF, Havranek EP, Krumholz HM.Insulin-Sensitizing Antihyperglycemic Drugs and Mortality After Acute Myocardial Infarction: Insights from the National Heart Care Project Diabetes Care 28:1680-1689, 2005.
10. Lautamaki R, Airaksinen KE, Seppanen M, Toikka J, Luotolahti M, Ball E, Borra R, Harkonen R, Iozzo P, Stewart M, Knuuti J, Nuutila P.Rosiglitazone Improves Myocardial Glucose Uptake in Patients With Type 2 Diabetes and Coronary Artery Disease Diabetes 54:2787-2794, 2005.
11. Scheuermann-Freestone et al, Circulation 108 Suppl IV: IV-60, abstract 277, 2003.
12. Richard W. Nesto, MD; David Bell, MD; Robert O. Bonow, MD; Vivian Fonseca, MD; Scott M. Grundy, MD, PhD; Edward S. Horton, MD; Martin Le Winter, MD; Daniel Porte, MD; Clay F. Semenkovich, MD; Sidney Smith, MD; Lawrence H. Young, MD; Richard Kahn, PhD. Thiazolidinedione Use, Fluid Retention, and Congestive Heart Failure Circulation. 2003;108:2941.
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