MedWire News: Patients with Type 2 diabetes do not face an altered risk for stroke if they take thiazolidinediones (TZDs), show the results of a population-based study.
The findings are consistent with those of previous studies, but the researchers stress that their results, which are based on data from the UK General Practice Research Database (GPRD), are more generalizable than previous findings.
Samy Suissa (Sir Mortimer B Davis Jewish General Hospital, Montreal, Quebec, Canada) and colleagues note the link between rosiglitazone use and increased risk for myocardial infarction.
“In light of these safety concerns on one hand and the need to aggressively manage patients with Type 2 diabetes on the other hand, the risk–benefit ratio of TZDs needs to be carefully assessed,” the team comments in the journal Pharmacoepidemiology and Drug Safety.
Also, in vitro research indicates that TZDs could have neuroprotective properties.
The GPRD contained 75,717 users of anti-diabetic drugs, 2417 of whom suffered a stroke while being prescribed the drugs. The researchers matched each these cases to up to 10 controls (stroke-free, anti-diabetic-drug users) by age, gender, year of first prescription of an oral hypoglycemic agent, and duration of follow-up (as a proxy for duration of diabetes).
Median follow-up was just 3.6 years, and the patients had a low prevalence of conditions associated with diabetic complications, such as renal failure, suggesting that most patients had a fairly recent disease onset.
Most patients were using metformin (63.4%) or sulfonylureas (33.6%), with a small minority (0.7%; n=522) using a TZD. The stroke rate ratios among patients currently taking a TZD were nonsignificant, at 1.20 for monotherapy, 0.78 for combination therapy, and 0.87 for both groups combined.
The only significant finding was an increased stroke rate ratio of 1.84 among patients who were not prescribed any anti-diabetic drugs in the 90 days prior to the stroke, but had used them between 91 and 365 days previously.
“The results of the present study indicate that TZDs do not appear to increase nor decrease the risk for incident strokes in a cohort of subjects with Type 2 diabetes,” the researchers conclude.
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