Abstract
Evaluation of: Lipscombe LL, Gomes T, Lévesque LE, Hux JE, Juurlink DN, Alter DA: Thiazolidinediones and cardiovascular outcomes in older patients with diabetes. JAMA 298, 2634–2643 (2007). Type 2 diabetes represents a heavy disease burden in the population and, especially, in elderly subjects. According to recent guidelines from the American Diabetes Association (ADA), the treatment of hyperglycemia should start with lifestyle advice and metformin. Subsequently, the physician can prescribe either insulin, sulphonylureas or thiazolidinediones (TZDs) according to efficacy, tolerability, safety and the cost of drugs. Recently, the TZD group has been scrutinized for an alleged increased cardiovascular risk, especially for congestive heart failure. This has led to a labeling of warning for prescribing physicians. In a recent Canadian ecological, observational study, the use of TZDs, most notably rosiglitazone, was associated with marked cardiovascular risks. However, observational studies are sensitive to bias by confounding factors such as increased baseline risk owing to restricted prescription patterns of TZDs as a second- or third-line drug choice. Therefore, additional randomized trials have to be conducted in order to finally define the appropriate role of TZDs for the treatment of Type 2 diabetes, particularly in elderly subjects at increased risk of cardiovascular disease.
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