Monday, August 02, 2010

AHA/ACCF Science Advisory on the use of TZDs and cardiovascular risk

The document is available on line here. Here are some excerpts from the summary:

Control of hyperglycemia is recommended to reduce microvascular complications; achievement of a hemoglobin A1c less than 7% without causing hypoglycemia may be particularly important, if accomplished early in the disease and maintained successfully.

This as well as other statements in the body of the paper seem to ignore recent evidence that the goal of less then 7% for HgbA1c may be too aggressive.

There is evidence that suggests a macrovascular benefit with metformin, especially for obese diabetic patients, and some inconclusive evidence of potential harm from rosiglitazone but not pioglitazone.

This statement, unfortunately, does not go far enough in acknowledging evidence for probable macrovascular benefit associated with the use of pioglitazone.

For most of the other glucose-lowering agents, there are few or no data to support either harm or benefit with regard to macrovascular disease.

That statement is simply wrong. There is ample evidence pointing to macrovascular harm associated with the use of sulfonylurea drugs, which carry a black box warning for that effect.

A related editorial in Circulation: Cardiovascular Quality and Outcomes is available here.

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