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Tiazolidinedionas y resultados cardiovasculares en pacientes mayores con diabetes
Lorraine L Lipscombe1, Tara Gomes, Linda E Lévesque
1Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. lorraine.lipscombe@ices.on.ca
JAMA
|December 13, 2007
Resumen
El uso de tiazolidinediona (TZD) en adultos mayores con diabetes tipo 2 aumenta los riesgos de insuficiencia cardíaca, ataque cardíaco y muerte. Estos riesgos estaban relacionados principalmente con la rosiglitazona en comparación con otros medicamentos para la diabetes.
Área de la Ciencia:
- Cardiología Cardiología.
- Endocrinología Endocrinología.
- Farmacología Farmacología.
Sus antecedentes:
- Las tiazolidinedionas (TZD) se usan para controlar la diabetes tipo 2.
- Estudios previos sugieren que los TZD pueden aumentar los riesgos de insuficiencia cardíaca congestiva e infarto de miocardio.
- Los datos a nivel de población sobre los riesgos cardiovasculares de la TZD son limitados.
Objetivo del estudio:
- Para investigar la asociación entre la terapia con tiazolidinediona (TZD) y los eventos cardiovasculares.
- Para comparar los riesgos de insuficiencia cardíaca congestiva, infarto agudo de miocardio y mortalidad entre los usuarios de TZD y los de otros agentes hipoglucémicos orales.
Principales métodos:
- Estudio de cohorte retrospectivo utilizando las bases de datos de atención médica de Ontario.
- Se incluyeron 159.026 pacientes de 66 años o más con diabetes tipo 2 que recibían agentes hipoglucémicos orales (2002-2005).
- Análisis de casos y controles anidados comparando la monoterapia de TZD (rosiglitazona, pioglitazona) con otras combinaciones de agentes hipoglucémicos orales, con seguimiento hasta el 31 de marzo de 2006.
Principales resultados:
- Durante una mediana de 3,8 años, la monoterapia de TZD mostró un aumento significativo de los riesgos de insuficiencia cardíaca congestiva (RR 1.60), infarto agudo de miocardio (RR 1.40) y mortalidad por cualquier causa (RR 1.29) en comparación con otros agentes orales.
- Estos riesgos elevados se asociaron principalmente con el uso de rosiglitazona.
- El estudio identificó 12.491 casos de insuficiencia cardíaca congestiva, 12.578 de infarto agudo del miocardio y 30.265 muertes.
Conclusiones:
- En pacientes diabéticos mayores, el tratamiento con tiazolidinediona, particularmente rosiglitazona, está relacionado con mayores riesgos de insuficiencia cardíaca congestiva, infarto agudo del miocardio y mortalidad.
- Los hallazgos sugieren una cuidadosa consideración del uso de TZD en esta población.
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