Pioglitazone heart failure with

Although the incidence of heart failure with pioglitazone or rosighatoze monotherapy is low, <1%, the American Heart Association and American Diabetes Association have a joint consensus statement regarding the use of TZD in patients with cardiovascular disease. They recommend TZDs to be used cautiously and initiated at low doses in patients with class I or n NYHA category heart failure, and they are not recommended in class m or IV heart failure. 

Cardiovascular Data from the PROactive study have been reexamined to investigate outcomes in 5238 patients with type 2 diabetes who also took nitrates, renin-angiotensin system blockers, or insulin [70 "j. These medications did not alter the response to pioglitazone heart failure remained a significant risk across all therapies. 

Cardiac effects Thiazolidinediones can cause fluid retention, which may exacerbate or lead to heart failure. Discontinue therapy if any deterioration in cardiac status occurs. Rosiglitazone and pioglitazone are not recommended in patients with NYHA Class 3 and 4 cardiac status. 

Edema Use pioglitazone and rosiglitazone with caution in patients with edema. Because thiazolidinediones can cause fluid retention, which can exacerbate or lead to CHF, use with caution in patients at risk for heart failure and monitor patients at risk for heart failure for signs and symptoms of heart failure. 

Diabetic patients often have significant cardiovascular risk factors, which may be exacerbated with TZD treatment. Congestive heart failure in diabetics treated concomitantly with insulin and TZDs has been reported. In placebo controlled trials the incidence of CHF was significantly higher in patients using pioglitazone and insulin (approximately 1%) versus patients on insulin alone [40]. 

The manufacturers say that pioglitazone and rosiglitazone can cause fluid retention, which may exacerbate or precipitate heart failure, particularly in those with limited cardiac reserve. " Because NSAIDs can also cause fluid retention, the manufacturers issue a warning that concurrent use may possibly increase the risk of oedema." ... 

Pioglitazone and rosiglitazone may cause fluid retention and peripheral oedema, which can worsen or cause heart failure. There is evidence that the incidence of these effects is higher when combined with insulin. The incidence of hypoglycaemia may also be increased. 

Out-patients ( = 39 736) aged 66 years or older who had used either pioglitazone or rosiglitazone were identified from the Ontario Public Drug Benefit Program prescription records [81 ]. Those who had taken pioglitazone had a lower risk of death or hospital admission for either acute myocardial infarction or heart failure compared with rosiglitazone, with an adjusted hazard ratio of 0.8. Further analysis showed that this was due to a reduction in death (adjusted hazard ratio = 0.86) and heart failure (0.77). There was no difference in the risk of acute myocardial infarction (0.95). 

Giles TD, Miller AB, Elkayam U, Bhattacharya M, Perez A. Pioglitazone and heart failure results from a controlled study in patients with type 2 diabetes mel-litus and systolic dysfunction. J Cardiac Fail 2008 14 445-52. 

Graham, D.J., Ouellet-Hellstrom, R., MaCurdy, T.E., Ali, F., Sholley, C., Worrall, C., and Kel-man, J.A. 2010. Risk of acute myocardial infarction, stroke, heart failure, and death in elderly Medicare patients treated with rosiglitazone or pioglitazone. JAMA The Journal of the American Medical Association, 304(4), 411-418. 

Cardiovascular The most commonly recognised side effect of pioglitazone is heart failure. In meta-analysis of 200 pioglitazone-treated patients (2.3%) compared with 139 (1.8%) of tiie control patients (HR = 1.41 95% Cl, 1.14-1.76 P = 0.002) serious heart failure was reported [59 ]. 

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