Evaluation of Thiazolidinediones on Cardiovascular Outcomes in Patients with Type 2 Diabetes Mellitus: A Systematic Review

Diabetes mellitus (DM) is a chronic disease regarded as a risk equivalent of coronary heart disease. Although pharmacologic therapy is an effective way to manage DM, a meta-analysis published in 2007 found clinically significant associations between rosiglitazone and increased myocardial infarction and cardiovascular deaths. In addition, thiazolidinediones (TZDs) have been shown to exert different effects on lipid profiles. The primary objective is to evaluate the effects of rosiglitazone on cardiovascular outcomes in patients with type 2 DM. The secondary objective is to assess the effects of rosiglitazone and pioglitazone on lipid profiles. Studies were obtained from selected electronic databases. Inclusion criteria for primary objective included randomized controlled trials with duration ≥ 24 weeks and primary or secondary outcome evaluating safety assessment. For the secondary objective, all randomized controlled trials conducted over the past 10 years comparing rosiglitazone versus pioglitazone and rosiglitazone/pioglitazone monotherapy versus placebo were included. Clinical trials with longer duration and improved quality, specifically designed to assess and evaluate the effects of rosiglitazone on cardiovascular risks, need to be conducted. In the interim, rosiglitazone appeared safe to be continued with close monitoring in patients without previous or current cardiovascular diseases. When the use of TZDs is deemed necessary, pioglitazone may be a better option, based on the available cardiovascular safety data and its potentially beneficial effects on lipid profiles.