Rosiglitazone is one of the thiazolidinedione groups which enhance insulin sensitivity through stimulating peroxisome proliferator-activated receptors in the adipose tissue, liver and muscle. Resulted in decrease glucose production and enhances its utilization. Fluid retention and weight gain are major side effect which limit its use for diabetes treatment, and caution should be done while prescribing those medications to patients with co-existing heart or kidney failure. The effect of rosiglitazone on composite cardiovascular outcome (myocardial infarction, cardiovascular death and stroke) is controversial due to conflicting results in published studies and meta-analysis. The conflicting data resulted from heterogeneity in the studied population, multiple genetic and non-genetic factors that will contribute to cardiovascular mortality in diabetic patients in addition to diabetes control, low number of cardiovascular events in newly diagnosed diabetic patients which render most of the studies under powered to detect a difference in mortality with different anti-diabetic medications. We therefore intend to do meta-analysis to combine the effect of various randomized control trials in composite cardiovascular outcome in rosiglitazone treated patients compared to other treatment modalities.
Methods:
We searched MEDLINE, Web site of the Food and Drug Administration for randomized control trials that utilize rosiglitazone in treatment for either diabetic or pre-diabetic patients. Criteria for inclusion in our meta-analysis included a study duration of more than 24 weeks, randomized control trials and the availability of composite cardiovascular outcome data. We used Review Manager ( RevMan) version 5.3 to calculate the relative risk using fixed effect model. In Preliminary search 56 potential randomized control trials were found and studied. 50 studied were excluded due to the lack of cardiovascular outcome data or short duration of follow up. 6 studies were included in the final meta-analysis
Results:
Six randomized control trials were included; three studies were double blinded while the other three were open labeled studies. Totally 8306 patients were received rosiglitazone and 9663 patients received different modality of anti-diabetic medications with median follow up of 4.25 years. The combined hazard ratio for composite cardiovascular outcome was 0.93 with 95% CI ranges from (0.7-1.23).
Conclusions:
Rosiglitazone hasn’t shown any increase risk for composite cardiovascular outcome (myocardial infarction, stroke or cardiovascular death). However caution while prescribing it in patients with heart failure and volume overload due to the risk of fluid retention and worsening heart failure symptoms.