Pioglitazone for the Primary and Secondary Prevention of Cardiovascular and Renal Outcomes in Patients with or at High Risk of Type 2 Diabetes Mellitus: A Meta-Analysis

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Yue Zhou 1, Yajing Huang 1, Xiaoyun Ji 1, Xiang Wang 1, Liyan Shen 1, Yangang Wang 1

Main idea: Pioglitazone should be considered in patients with or at high risk of T2DM for the prevention of cardiovascular endpoints, especially in those with a history of established CVD who might benefit the most. Robust reductions in progression of renal disease are seen regardless of baseline renal function degree.

Abstract

Context: The goal of the meta-analysis was to evaluate the effect of pioglitazone on the primary and secondary prevention of cardiovascular diseases (CVDs) and renal adverse events in patients with or at high risk of type 2 diabetes mellitus (T2DM).

Design: Randomized controlled trials (RCTs) comparing pioglitazone with any control were identified through PubMed, Embase, and the Cochrane Library. Cardiovascular outcomes included major adverse cardiovascular events (MACEs, defined as the composite of nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death), hospitalization for heart failure, and all-cause mortality. Renal outcomes included change in urinary albumin to creatinine ratio and 24-hour urinary protein excretion. Weighted mean difference (WMD) and risk ratio (RR) with 95% confidence intervals (CIs) were pooled. Results: Pioglitazone reduced the risk of MACE with benefit only seen in patients with a history of established CVDs. No treatment effect was found on cardiovascular death, regardless of CVD history. Piog litazone also reduced albuminuria by 18.5% and had no treatment effect on all-cause mortality. The drug was found to have no effect on heart failure, stroke, myocardial infarction, or cardiovascular death.  

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