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Rosiglitazone and Myocardial Infarction in Patients Previously Prescribed Metformin

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  • Colin R Dormuth
  • Malcolm Maclure
  • Greg Carney
  • Sebastian Schneeweiss
  • Ken Bassett
  • James M Wright

Abstract

Objective: Rosiglitazone was found associated with approximately a 43% increase in risk of acute myocardial infarction (AMI) in a two meta-analyses of clinical trials. Our objective is to estimate the magnitude of the association in real-world patients previously treated with metformin. Research Design and Methods: We conducted a nested case control study in British Columbia using health care databases on 4.3 million people. Our cohort consisted of 158,578 patients with Type 2 diabetes who used metformin as first-line drug treatment. We matched 2,244 cases of myocardial infarction (AMI) with up to 4 controls. Conditional logistic regression models were used to estimate matched odds ratios for AMI associated with treatment with rosiglitazone, pioglitazone and sulfonylureas. Results: In our cohort of prior metformin users, adding rosiglitazone for up to 6 months was not associated with an increased risk of AMI compared to adding a sulfonylurea (odds ratio [OR] 1.38; 95% confidence interval [CI], 0.91–2.10), or compared to adding pioglitazone (OR for rosi versus pio 1.41; 95% CI, 0.74–2.66). There were also no significant differences between rosiglitazone, pioglitazone and sulfonylureas for longer durations of treatment. Though not significantly different from sulfonylureas, there was a transient increase in AMI risk associated with the first 6 months of treatment with a glitazone compared to not using the treatment (OR 1.53; 95% CI, 1.13–2.07) Conclusions: In our British Columbia cohort of patients who received metformin as first-line pharmacotherapy for Type 2 diabetes mellitus, further treatment with rosiglitazone did not increase the risk of AMI compared to patients who were treated with pioglitazone or a sulfonylurea. Though not statistically significantly different compared from each other, an increased risk of AMI observed after starting rosiglitazone or sulfonylureas is a matter of concern that requires more research.

Suggested Citation

  • Colin R Dormuth & Malcolm Maclure & Greg Carney & Sebastian Schneeweiss & Ken Bassett & James M Wright, 2009. "Rosiglitazone and Myocardial Infarction in Patients Previously Prescribed Metformin," PLOS ONE, Public Library of Science, vol. 4(6), pages 1-7, June.
    • Handle: RePEc:plo:pone00:0006080
    DOI: 10.1371/journal.pone.0006080
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    1. Fisher, E.S. & Whaley, F.S. & Krushat, W.M. & Malenka, D.J. & Fleming, C. & Baron, J.A. & Hsia, D.C., 1992. "The accuracy of Medicare's hospital claims data: Progress has been made, but problems remain," American Journal of Public Health, American Public Health Association, vol. 82(2), pages 243-248.
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