Rosiglitazone and outcomes for patients with diabetes mellitus and coronary artery disease in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial.

Abstract

BACKGROUND:

Rosiglitazone improves glycemic control for patients with type 2 diabetes mellitus, but there remains controversy regarding an observed association with cardiovascular hazard. The cardiovascular effects of rosiglitazone for patients with coronary artery disease remain unknown.

METHODS AND RESULTS:

To examine any association between rosiglitazone use and cardiovascular events among patients with diabetes mellitus and coronary artery disease, we analyzed events among 2368 patients with type 2 diabetes mellitus and coronary artery disease in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial. Total mortality, composite death, myocardial infarction, and stroke, and the individual incidence of death, myocardial infarction, stroke, congestive heart failure, and fractures, were compared during 4.5 years of follow-up among patients treated with rosiglitazone versus patients not receiving a thiazolidinedione by use of Cox proportional hazards and Kaplan-Meier analyses that included propensity matching. After multivariable adjustment, among patients treated with rosiglitazone, mortality was similar (hazard ratio [HR], 0.83; 95% confidence interval [CI], 0.58-1.18), whereas there was a lower incidence of composite death, myocardial infarction, and stroke (HR, 0.72; 95% CI, 0.55-0.93) and stroke (HR, 0.36; 95% CI, 0.16-0.86) and a higher incidence of fractures (HR, 1.62; 95% CI, 1.05-2.51); the incidence of myocardial infarction (HR, 0.77; 95% CI, 0.54-1.10) and congestive heart failure (HR, 1.22; 95% CI, 0.84-1.82) did not differ significantly. Among propensity-matched patients, rates of major ischemic cardiovascular events and congestive heart failure were not significantly different.

CONCLUSIONS:

Among patients with type 2 diabetes mellitus and coronary artery disease in the BARI 2D trial, neither on-treatment nor propensity-matched analysis supported an association of rosiglitazone treatment with an increase in major ischemic cardiovascular events.

CLINICAL TRIAL REGISTRATION:

URL: http://www.clinicaltrials.gov. Unique identifier: NCT00006305.

• Authors: Richard G Bach, Maria Mori Brooks, Manuel Lombardero, Saul Genuth, Thomas W Donner, Alan Garber, Laurence Kennedy, E Scott Monrad, Rodica Pop-Busui, Sheryl F Kelsey, Robert L Frye, BARI 2D Investigators
• Journal: Circulation (Circulation) Vol. 128 Issue 8 Pg. 785-94 (Aug 20 2013) ISSN: 1524-4539 [Electronic] United States
• PMID: 23857320 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Hypoglycemic Agents
• Thiazolidinediones
• Rosiglitazone

Topics

• Aged
• Angioplasty
• Comorbidity
• Coronary Artery Disease (epidemiology, mortality, therapy)
• Diabetes Mellitus, Type 2 (drug therapy, epidemiology, mortality)
• Female
• Follow-Up Studies
• Heart Failure (epidemiology)
• Humans
• Hypoglycemic Agents (adverse effects, therapeutic use)
• Incidence
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Myocardial Infarction (epidemiology)
• Retrospective Studies
• Risk Factors
• Rosiglitazone
• Stroke (epidemiology)
• Thiazolidinediones (adverse effects, therapeutic use)
• Treatment Outcome