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Q: What is the risk for CHF in persons using TZDs?
A: In clinical trials of patients taking TZDs (monotherapy), the incidence of CHF was <1%. When TZDs were used in combination with insulin, rates increased to 2% to 3%, compared with 1% in patients taking insulin monotherapy.1 A retrospective, observational study of health insurance claims over a 5-year period determined that the risk of CHF among patients with diabetes was 4.5% in patients prescribed TZDs and 2.6% in those not using a TZD.6 Increased risk was also associated with advanced age, history of coronary artery disease, diabetes-related, end-organ disease, and the use of angiotensin-converting enzyme inhibitors, beta-blockers, or insulin. Another analysis of claims data showed similar results. Thus, it is important to realize that patients with type 2 diabetes are at high risk for CHF at baseline. After a review of these and other applicable studies, the American Heart Association (AHA) and American Diabetes Association (ADA) issued a joint Consensus Statement regarding TZD use, fluid retention, and CHF. Although a number of reports have described CHF in patients treated with TZDs, most cases occurred in combination with insulin and were preceded by the appearance of edema. The AHA/ADA Consensus Statement concludes that although edema may be relatively common with TZDs, the excess risk of CHF attributable to the TZD is very small, and that CHF can occur in patients with diabetes by unmasking previously asymptomatic and unrecognized diastolic dysfunction.1
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