TORONTO — A retrospective analysis has shown no adverse effects of thiazolidinediones on diabetic heart failure patients.
Thiazolidinedione (TZD) use was associated with reductions in all-cause hospitalizations, heart failure hospitalizations, and total hospital days. The reduction in hospital days also was noted with TZD plus insulin.
The findings challenge recommendations against using TZDs in heart failure based on concerns about fluid retention, particularly when used in combination with insulin. No trials have assessed the impact of TZD therapy on heart failure.
“Perhaps the nonhypoglycemic cardiovascular effects of TZDs may have favorable clinical impact in heart failure patients,” John S. Golden, M.D., said during a poster presentation at the annual meeting of the Heart Failure Society of America.
“I can't tell you on the basis of this study that it is something we ought to be doing as a therapeutic intervention at this point,” said Dr. Golden of Mid-Atlantic Permanente Medical Group, Fairfax, Va. But the study “lends some clinical support to the biochemical mechanisms supporting not only the safety, but efficacy, of TZDs in this population.”
Consecutively, 97 diabetic patients were referred with left ventricular ejection fractions of 35% or less and New York Heart Association (NYHA) class II-IV. A total of 37% were treated with a TZD and 15% with a TZD plus insulin. All received ACE inhibitors or angiotensin receptor blockers; 97% got ?-blockers.
At 1 year, improvements in ejection fractions did not differ significantly between patients treated with TZDs and those who were not. TZD therapy led to reduced all-cause hospitalizations per patient (0.19 vs. 0.71), heart failure hospitalizations per patient (0.03 vs. 0.16), and total hospital days (0.67 vs. 2.72).
Patients on TZD plus insulin had a reduction in total hospital days per patient (0.07 vs. 2.30), compared with those not on the combination therapy.