Author + information
- Received November 30, 2006
- Revision received January 11, 2007
- Accepted January 16, 2007
- Published online July 3, 2007.
- David Aguilar, MD⁎,⁎ (, )
- Biykem Bozkurt, MD, FACC⁎,†,
- Allison Pritchett, MD, FACC⁎,
- Nancy J. Petersen, PhD† and
- Anita Deswal, MD, MPH, FACC⁎,†,‡
- ↵⁎Reprint requests and correspondence:
Dr. David Aguilar, Cardiovascular Division, Baylor College of Medicine, 1709 Dryden Street, BCM 620, Suite 500, Box 13, Houston, Texas 77030.
Objectives This study sought to examine the relationship between thiazolidinedione (TZD) use and outcomes in ambulatory patients with diabetes and heart failure (HF).
Background Thiazolidinediones have been relatively contraindicated in diabetic patients with HF.
Methods We conducted a retrospective study of a national cohort of veterans with HF and diabetes treated in ambulatory clinics at Veterans Affairs medical centers. Patients were classified into those using TZDs and those not using insulin-sensitizing medication based on prescriptions filled 90 days before or 30 days after the index outpatient visit. The outcomes were time to hospitalization for HF and time to death.
Results Of 7,147 ambulatory HF patients receiving diabetic therapy, 818 (11.4%) were receiving a TZD and 4,700 (65.8%) were not receiving insulin sensitizers. Over 2 years of follow-up, 134 (16.4%) patients receiving TZDs and 741 (15.8%) patients not receiving insulin-sensitizing medications required HF hospitalization (adjusted hazard ratio 1.00, 95% confidence interval 0.81 to 1.24, p = 0.97). A total of 168 (20.5%) patients receiving TZDs and 1,192 (25.4%) patients not receiving insulin-sensitizing medications died (adjusted hazard ratio 0.98, 95% confidence interval 0.81 to 1.17, p = 0.80).
Conclusions In ambulatory patients with established HF and diabetes, the use of TZDs was not associated with an increased risk of HF hospitalization or total mortality when compared with those not receiving insulin-sensitizing medications.
This study was supported in part by a grant (IIR 02-082-1) from the Health Services Research and Development Service, Department of Veterans Affairs. Dr. Deswal is a recipient of an Advanced Clinical Research Career Development Award (CRCD 712A) from the Cooperative Studies Program, Department of Veterans Affairs. Dr. Aguilar is a recipient of a National Institutes of Health Mentored Clinical Investigator Award (5K12RR017665-05).
- Received November 30, 2006.
- Revision received January 11, 2007.
- Accepted January 16, 2007.
- American College of Cardiology Foundation