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The rough road for rosiglitazone

Goldfine, Allison Ba,b

Current Opinion in Endocrinology, Diabetes and Obesity: April 2008 - Volume 15 - Issue 2 - p 113–117
doi: 10.1097/MED.0b013e3282f8b483
Diabetes and the endocrine pancreas: Edited by Allison B. Goldfine

Purpose of review Rosiglitazone is effective in lowering blood sugars in patients with type 2 diabetes and may be expected to reduce microvascular complications associated with hyperglycemia. Whereas preliminary studies using surrogate outcomes for cardiovascular disease have suggested the potential for cardioprotective effects, the drug is associated with fluid retention and increased risk of congestive heart failure. Long-term cardiovascular safety remains incompletely understood. In this review the potential for increased ischemic cardiovascular risk associated with rosiglitazone use is discussed.

Recent findings Meta-analysis of patients participating in controlled clinical trials suggests increased risk of cardiovascular events for patients using rosiglitazone. Considering only clinical trials in patients with type 2 diabetes with patient-level data, a double-masked, randomized design, and using approved doses of rosiglitazone, independent meta-analysis shows that cardiovascular event rates are low, and suggests that increased ischemic cardiovascular risk may be particularly manifest in subgroups of patients with type 2 diabetes who are using nitrates or insulin.

Summary There continues to be uncertainty about the risk of ischemic heart disease in patients with type 2 diabetes associated with the use of rosiglitazone. Caution should be used in patients with underlying heart disease using nitrates, and when added to ongoing insulin-based therapy.

aHarvard Medical School, USA

bJoslin Diabetes Center, Boston, Massachusetts, USA

Correspondence to Allison B. Goldfine, MD, Joslin Diabetes Center, One Joslin Place, Boston, MA 02215, USA Tel: +1 617 732 2643; fax: +1 617 713 3403; e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.