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シアゾリジンジオンと糖尿病の高齢患者における心血管疾患のアウトカム
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
まとめ
2型糖尿病の高齢者におけるシアゾリジンジオン (TZD) の使用は,心不全,心臓発作,死亡のリスクを高めます. これらのリスクは,他の糖尿病薬と比較して,主にロシグリタゾンに関連していました.
科学分野:
- 心臓病学 心臓病学
- エンドクリノロジー エンドクリノロジー
- 薬理学 薬理学とは
背景:
- シアゾリジンジオン (TZD) は,2型糖尿病の管理に使用されます.
- 以前の研究では,TZDsは,心不全と心筋梗塞のリスクを増やす可能性があることを示唆しています.
- TZDの心血管リスクに関する集団レベルのデータは限られている.
研究 の 目的:
- シアゾリジディネイオン (TZD) 治療と心血管疾患との関連を調査する.
- 閉塞性心不全,急性心筋梗塞,およびTZD使用者と他の経口低血糖剤を使用する人の間の死亡率のリスクを比較するために.
主な方法:
- オンタリオ州のヘルスケアデータベースを利用した遡及的なコホート研究.
- 2型糖尿病の66歳以上の159,026人の患者が,口服低血糖薬 (2002年-2005年) を服用していた.
- TZD (ロシグリタゾン,ピオグリタゾン) モノセラピーと他の経口低血糖剤の組み合わせを比較した内蔵症例対照分析を行い,2006年3月31日まで追跡調査を行った.
主要な成果:
- 平均3.8年間,TZD単独療法では,他の経口薬と比較して,充血性心不全 (RR 1.60),急性心筋梗塞 (RR 1.40),全因死亡率 (RR 1.29) のリスクが著しく増加しました.
- これらの高いリスクは主にロシグリタゾンの使用と関連していました.
- この研究では,12,491例の充血性心不全,12,578例の急性心筋梗塞,30,265例の死亡が確認されました.
結論:
- 高齢の糖尿病患者では,チアゾリジンダイオン治療,特にロシグリタゾンは,充血性心不全,急性心筋梗塞,および死亡率のリスクが高いと関連しています.
- 発見は,この集団におけるTZDの使用を慎重に検討することを示唆しています.
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