Pioglitazone and cardiovascular outcomes in patients with insulin resistance, pre-diabetes and type 2 diabetes: A systematic review and meta-analysis

Hung Wei Liao, Jeffrey L. Saver, Yi Ling Wu, Tso Hsiao Chen, Meng Lee, Bruce Ovbiagele

Research output: Contribution to journalReview article

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Abstract

Objectives: To evaluate the effect of pioglitazone in people with insulin resistance, pre-diabetes and type 2 diabetes. Design and setting: Systematic review and metaanalysis of randomised, controlled trials. Data sources: Literature searches were performed across PubMed, EMBASE, MEDLINE and Cochrane Central Register of Controlled Trials from 1966 to May 2016 to identify randomised, controlled trials with more than 1 year follow-up. Outcome measures: Relative risk (RR) with 95% CI was used to evaluate the association between pioglitazone and the risk of major adverse cardiovascular events (MACE: composite of non-fatal myocardial infarction, non-fatal stroke and cardiovascular death) and safety outcomes, after pooling data across trials in a fixed-effects model. Results: Nine trials with 12 026 participants were enrolled in the current meta-analysis. Pioglitazone therapy was associated with a lower risk of MACE in patients with pre-diabetes or insulin resistance (RR 0.77, 95% CI 0.64 to 0.93), and diabetes (RR 0.83, 95% CI 0.72 to 0.97). Risks of heart failure (RR 1.32; CI 1.14 to 1.54), bone fracture (RR 1.52, 95% CI 1.17 to 1.99), oedema (RR, 1.63; CI 1.52 to 1.75) and weight gain (RR 1.60; CI 1.50 to 1.72) increased in pioglitazone group. Conclusions: Pioglitazone was associated with reduced risk of MACE in people with insulin resistance, pre-diabetes and diabetes mellitus. However, the risks of heart failure, bone fracture, oedema and weight gain were increased.

Original languageEnglish
Article numbere013927
JournalBMJ Open
Volume7
Issue number1
DOIs
Publication statusPublished - Jan 1 2017

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pioglitazone
Type 2 Diabetes Mellitus
Insulin Resistance
Meta-Analysis
Bone Fractures
Weight Gain
Edema
Randomized Controlled Trials
Heart Failure
Myocardial Infarction

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Pioglitazone and cardiovascular outcomes in patients with insulin resistance, pre-diabetes and type 2 diabetes : A systematic review and meta-analysis. / Liao, Hung Wei; Saver, Jeffrey L.; Wu, Yi Ling; Chen, Tso Hsiao; Lee, Meng; Ovbiagele, Bruce.

In: BMJ Open, Vol. 7, No. 1, e013927, 01.01.2017.

Research output: Contribution to journalReview article

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abstract = "Objectives: To evaluate the effect of pioglitazone in people with insulin resistance, pre-diabetes and type 2 diabetes. Design and setting: Systematic review and metaanalysis of randomised, controlled trials. Data sources: Literature searches were performed across PubMed, EMBASE, MEDLINE and Cochrane Central Register of Controlled Trials from 1966 to May 2016 to identify randomised, controlled trials with more than 1 year follow-up. Outcome measures: Relative risk (RR) with 95{\%} CI was used to evaluate the association between pioglitazone and the risk of major adverse cardiovascular events (MACE: composite of non-fatal myocardial infarction, non-fatal stroke and cardiovascular death) and safety outcomes, after pooling data across trials in a fixed-effects model. Results: Nine trials with 12 026 participants were enrolled in the current meta-analysis. Pioglitazone therapy was associated with a lower risk of MACE in patients with pre-diabetes or insulin resistance (RR 0.77, 95{\%} CI 0.64 to 0.93), and diabetes (RR 0.83, 95{\%} CI 0.72 to 0.97). Risks of heart failure (RR 1.32; CI 1.14 to 1.54), bone fracture (RR 1.52, 95{\%} CI 1.17 to 1.99), oedema (RR, 1.63; CI 1.52 to 1.75) and weight gain (RR 1.60; CI 1.50 to 1.72) increased in pioglitazone group. Conclusions: Pioglitazone was associated with reduced risk of MACE in people with insulin resistance, pre-diabetes and diabetes mellitus. However, the risks of heart failure, bone fracture, oedema and weight gain were increased.",
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T1 - Pioglitazone and cardiovascular outcomes in patients with insulin resistance, pre-diabetes and type 2 diabetes

T2 - A systematic review and meta-analysis

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AU - Wu, Yi Ling

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AU - Lee, Meng

AU - Ovbiagele, Bruce

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N2 - Objectives: To evaluate the effect of pioglitazone in people with insulin resistance, pre-diabetes and type 2 diabetes. Design and setting: Systematic review and metaanalysis of randomised, controlled trials. Data sources: Literature searches were performed across PubMed, EMBASE, MEDLINE and Cochrane Central Register of Controlled Trials from 1966 to May 2016 to identify randomised, controlled trials with more than 1 year follow-up. Outcome measures: Relative risk (RR) with 95% CI was used to evaluate the association between pioglitazone and the risk of major adverse cardiovascular events (MACE: composite of non-fatal myocardial infarction, non-fatal stroke and cardiovascular death) and safety outcomes, after pooling data across trials in a fixed-effects model. Results: Nine trials with 12 026 participants were enrolled in the current meta-analysis. Pioglitazone therapy was associated with a lower risk of MACE in patients with pre-diabetes or insulin resistance (RR 0.77, 95% CI 0.64 to 0.93), and diabetes (RR 0.83, 95% CI 0.72 to 0.97). Risks of heart failure (RR 1.32; CI 1.14 to 1.54), bone fracture (RR 1.52, 95% CI 1.17 to 1.99), oedema (RR, 1.63; CI 1.52 to 1.75) and weight gain (RR 1.60; CI 1.50 to 1.72) increased in pioglitazone group. Conclusions: Pioglitazone was associated with reduced risk of MACE in people with insulin resistance, pre-diabetes and diabetes mellitus. However, the risks of heart failure, bone fracture, oedema and weight gain were increased.

AB - Objectives: To evaluate the effect of pioglitazone in people with insulin resistance, pre-diabetes and type 2 diabetes. Design and setting: Systematic review and metaanalysis of randomised, controlled trials. Data sources: Literature searches were performed across PubMed, EMBASE, MEDLINE and Cochrane Central Register of Controlled Trials from 1966 to May 2016 to identify randomised, controlled trials with more than 1 year follow-up. Outcome measures: Relative risk (RR) with 95% CI was used to evaluate the association between pioglitazone and the risk of major adverse cardiovascular events (MACE: composite of non-fatal myocardial infarction, non-fatal stroke and cardiovascular death) and safety outcomes, after pooling data across trials in a fixed-effects model. Results: Nine trials with 12 026 participants were enrolled in the current meta-analysis. Pioglitazone therapy was associated with a lower risk of MACE in patients with pre-diabetes or insulin resistance (RR 0.77, 95% CI 0.64 to 0.93), and diabetes (RR 0.83, 95% CI 0.72 to 0.97). Risks of heart failure (RR 1.32; CI 1.14 to 1.54), bone fracture (RR 1.52, 95% CI 1.17 to 1.99), oedema (RR, 1.63; CI 1.52 to 1.75) and weight gain (RR 1.60; CI 1.50 to 1.72) increased in pioglitazone group. Conclusions: Pioglitazone was associated with reduced risk of MACE in people with insulin resistance, pre-diabetes and diabetes mellitus. However, the risks of heart failure, bone fracture, oedema and weight gain were increased.

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