TY - JOUR
T1 - Effects of Thiazolidinediones on Cardiovascular Events in Patients With Type 2 Diabetes Mellitus After Drug-Eluting Stent Implantation
T2 - A Retrospective Cohort Study Using the National Health Insurance Database in Taiwan
AU - Yeh, Hsien Tsung
AU - Hsieh, Chi Feng
AU - Tsai, Yi Wen
AU - Huang, Weng Foung
N1 - Funding Information:
We thank the Bureau of National Health Insurance (BNHI) and National Health Research Institutes (NHRI) for making these databases available. The interpretation and conclusions contained herein do not represent those of BNHI or NHRI. This research was supported by the National Science Council ( NSC99-2320-B-010-018-MY3 ). All of the authors participated in the preparation of the article and the design of the study. Mr. Yeh and Mr. Hsieh performed the literature search and statistical analysis, and wrote the first draft of the article. Dr. Tsai provided consultation in study design and statistical analysis. Dr. Huang provided substantial revisions to the article and was the project leader.
PY - 2012/4
Y1 - 2012/4
N2 - Background: Thiazolidinediones (TZDs) may reduce in-stent restenosis and improve clinical outcomes in type 2 diabetic patients after bare-metal stent implantation. However, it is still unknown whether diabetic patients with drug-eluting stents (DESs) could benefit from treatment with TZDs. Objective: The objective was to evaluate the clinical outcomes of TZDs in type 2 diabetic patients within 1 year of receiving DESs. Methods: This retrospective cohort study was performed in 1743 Taiwanese type 2 diabetic patients (1137 men; 606 women) who received DESs between December 1, 2006 and December 31, 2007. Patients were classified into TZD (n = 268) or non-TZD groups (n = 1,475) using medication records within 3 months of the index hospitalization. Follow-up data were available through December 31, 2008. Clinical outcome measurements included death, myocardial infarction (MI), and repeat revascularization within 1 year after the index date of hospitalization. Cox proportional hazards model and other analyses were performed for the study. Results: For the TZD and non-TZD groups, the mean ages were 65.07 and 66.09 years, respectively, for those with limus-eluting stents (LESs) and 65.61 and 65.81 years, respectively, for those with paclitaxel-eluting stents (PESs). With or without TZD medication, there were no significant differences in the adjusted hazard ratios of death, MI, or repeat revascularization for diabetic patients who received LESs or PESs. TZD treatment in patients who received LESs and had a history of MI was associated with a higher risk of MI (hazard ratio = 5.292; 95% CI, 1.028-27.232). Conclusions: TZDs did not improve the clinical outcomes in Taiwanese type 2 diabetes patients who received DESs. TZDs might have been a contributor to higher risk of MI in patients with LESs and a history of MI. Larger clinical trials are still needed to study this issue further.
AB - Background: Thiazolidinediones (TZDs) may reduce in-stent restenosis and improve clinical outcomes in type 2 diabetic patients after bare-metal stent implantation. However, it is still unknown whether diabetic patients with drug-eluting stents (DESs) could benefit from treatment with TZDs. Objective: The objective was to evaluate the clinical outcomes of TZDs in type 2 diabetic patients within 1 year of receiving DESs. Methods: This retrospective cohort study was performed in 1743 Taiwanese type 2 diabetic patients (1137 men; 606 women) who received DESs between December 1, 2006 and December 31, 2007. Patients were classified into TZD (n = 268) or non-TZD groups (n = 1,475) using medication records within 3 months of the index hospitalization. Follow-up data were available through December 31, 2008. Clinical outcome measurements included death, myocardial infarction (MI), and repeat revascularization within 1 year after the index date of hospitalization. Cox proportional hazards model and other analyses were performed for the study. Results: For the TZD and non-TZD groups, the mean ages were 65.07 and 66.09 years, respectively, for those with limus-eluting stents (LESs) and 65.61 and 65.81 years, respectively, for those with paclitaxel-eluting stents (PESs). With or without TZD medication, there were no significant differences in the adjusted hazard ratios of death, MI, or repeat revascularization for diabetic patients who received LESs or PESs. TZD treatment in patients who received LESs and had a history of MI was associated with a higher risk of MI (hazard ratio = 5.292; 95% CI, 1.028-27.232). Conclusions: TZDs did not improve the clinical outcomes in Taiwanese type 2 diabetes patients who received DESs. TZDs might have been a contributor to higher risk of MI in patients with LESs and a history of MI. Larger clinical trials are still needed to study this issue further.
KW - Cardiovascular events
KW - Clinical Outcomes
KW - Diabetic Patients
KW - Drug Eluting Stent (DES)
KW - Thiazolidinediones
UR - http://www.scopus.com/inward/record.url?scp=84859588797&partnerID=8YFLogxK
U2 - 10.1016/j.clinthera.2012.02.024
DO - 10.1016/j.clinthera.2012.02.024
M3 - Article
C2 - 22440193
AN - SCOPUS:84859588797
SN - 0149-2918
VL - 34
SP - 885
EP - 893
JO - Clinical Therapeutics
JF - Clinical Therapeutics
IS - 4
ER -
