Key result
Pioglitazone reduces the risk of major adverse cardiovascular events in patients with or at high risk of type 2 diabetes, but does not significantly affect all-cause mortality and increases the risk of heart failure hospitalizations.
Why the study?
Clinical trial data have not presented conclusive proof regarding the positive or negative impact of pioglitazone on cardiac function despite known fluid retention concerns.
Does pioglitazone reduce major adverse cardiovascular events, all-cause mortality, and heart failure hospitalizations in patients with type 2 diabetes, pre-diabetes, or insulin resistance?
Systematic Review
Does pioglitazone reduce major adverse cardiovascular events, all-cause mortality, and heart failure hospitalizations in patients with type 2 diabetes, pre-diabetes, or insulin resistance?
Pioglitazone is a viable option for preventing cardiovascular endpoints in patients with or at high risk of T2DM, particularly those with established CVD, though its use must be weighed against an increased risk of heart failure hospitalizations.
Supports pioglitazone for MACE reduction in high-risk T2DM; confirms benefit while highlighting HF hospitalization trade-off.
Modern diabetic treatment has gone beyond glycemic control, with the choice of different medications to attain therapeutic targets also affected by the risk of long-term outcomes and safety profiles. The effect of diabetes on increased morbidity and mortality and its relationship to cardiovascular outcomes and coronary artery diseases have driven recent diabetes studies toward medications that improve cardiovascular outcomes and reduce all-cause mortality. This is attained by holistically treating cardiovascular complications in type 2 diabetic patients beyond glycemic control. Moreover, both diabetes and pre-diabetes are considered risk factors for both microvascular and macrovascular cardiac events. Despite the fact that initial research acknowledged fluid retention as a safety issue in pioglitazone use, clinical trial data have not presented conclusive proof of a positive or negative impact on cardiac function. This comprehensive literature review aims to evaluate the effect of pioglitazone on all-cause mortality, hospitalizations for heart failure, and major adverse cardiovascular outcomes, including the individual outcomes of non-fatal stroke, non-fatal myocardial infarction, and cardiovascular mortality.
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Sheikh et al. (2023) conducted a systematic review in Type 2 diabetes mellitus, pre-diabetes, and insulin resistance. Pioglitazone vs. Control (placebo, other glucose-lowering agents, or insulin) was evaluated on Major adverse cardiovascular events, all-cause mortality, and heart failure hospitalizations. Pioglitazone reduces the risk of major adverse cardiovascular events in patients with or at high risk of type 2 diabetes, but does not significantly affect all-cause mortality and increases the risk of heart failure hospitalizations.
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