Thiazolidinediones and Risk of Repeat Target Vessel Revascularization Following Percutaneous Coronary Intervention
A meta-analysis
- Daniel M. Riche, PHARMD1,
- Rodrigo Valderrama, MD2 and
- Nickole N. Henyan, PHARMD1
- 1University of Mississippi School of Pharmacy, Jackson, Mississippi
- 2University of Mississippi Medical Center, Jackson, Mississippi
- Address correspondence and reprint requests to Nickole N. Henyan, PharmD, Assistant Professor, University of Mississippi School of Pharmacy, Department of Pharmacy Practice, University of Mississippi Medical Center, Office Annex Building, WW 116, 2500 North State St., Jackson, MS 39216. E-mail: nhenyan{at}sop.umsmed.edu
Abstract
OBJECTIVE—Thiazolidinediones (TZDs) (rosiglitazone and pioglitazone) are a class of antidiabetes agents that have a high affinity for peroxisome proliferator–activated receptor-γ. TZDs initiate a multitude of physiologic processes that may elicit benefits as systemic agents for the prevention of restenosis requiring revascularization following percutaneous coronary intervention (PCI). Numerous trials have evaluated the impact of TZDs on repeat target vessel revascularization (TVR) in patients following PCI; however, several limitations (small sample size, inconclusive results, and risk factor stratification) complicate definitive conclusions. A meta-analysis was performed to evaluate the impact of TZDs on repeat TVR following PCI.
RESEARCH DESIGN AND METHODS—Included trials met the following criteria: 1) prospective, randomized controlled trials evaluating available TZDs versus standards of care; 2) well-described protocol; 3) minimum of 6 months of follow-up; and 4) data provided on repeat TVR. Data are presented as relative risks (RRs) with 95% CIs.
RESULTS—Seven clinical trials (n = 608) met the inclusion criteria. Upon meta-analysis, the risk of repeat TVR was significantly reduced in patients who received TZD therapy compared with standards of care (RR 0.35 [95% CI 0.22–0.57]). In studies using rosiglitazone (0.45 [0.25–0.83]) and pioglitazone (0.24 [0.11–0.51]), risk of repeat TVR was significantly reduced. Risk of repeat TVR was also significantly reduced among patients with (0.34 [0.19–0.63]) and without (0.37 [0.18–0.77]) diabetes.
CONCLUSIONS—Results from this meta-analysis suggest that TZDs effectively reduce the risk of repeat TVR following PCI.
- PCI, percutaneous coronary intervention
- PPAR, peroxisome proliferator–activated receptor
- TVR, target vessel revascularization
- TZD, thiazolidinedione
- VSMC, vascular smooth muscle cell
Footnotes
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A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.
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- Accepted November 8, 2006.
- Received September 5, 2006.
- DIABETES CARE
