Doi:10.1016/j.cardfail.2008.02.007
Journal of Cardiac Failure Vol. 14 No. 6 2008 Pioglitazone and Heart Failure: Results From a Controlled Study in Patients With Type 2 Diabetes Mellitus and Systolic Dysfunction THOMAS D. GILES, ALAN B. MILLER, MD,URI ELKAYAM, MONDIRA BHATTACHARYA, MD,AND ALFONSO PEREZ, New Orleans, Louisiana; Jacksonville, Florida; Los Angeles, California; Deerfield, Illinois Background: Thiazolidinediones are associated with fluid retention, often interpreted as worsening car-diac function, limiting their use in patients with heart failure (HF). We compared the effects of pioglita-zone and glyburide on cardiac function in patients with type 2 diabetes, systolic dysfunction, and NewYork Heart Association (NYHA) functional Class II/III HF.Methods and Results: Participants received pioglitazone or glyburide (6insulin) for 6 months in thisdouble-blind, randomized, multicenter study. The primary end point was time to HF, a composite ofcardiovascular mortality and hospitalization or emergency room (ER) visit for HF. Secondary endpointsincluded echocardiographic and functional classification assessments. An earlier time to onset and higherincidence of the primary endpoint was noted with pioglitazone (13%) versus glyburide (8%) (P 5 .024).Hospitalization or ER visit occurred in 30 pioglitazone and 15 glyburide participants, 19 and 12 of whom,respectively, continued treatment. Cardiac mortality (5 versus 6 participants, respectively) and cardiacfunction, as measured by change in ventricular mass index (P 5 .959), ejection fraction (P 5 .413), orfractional shortening (P 5 .280), were similar between treatments.Conclusions: Pioglitazone was associated with a higher incidence of hospitalization for HF without anincrease in cardiovascular mortality or worsening cardiac function (by echocardiography). (J CardiacFail 2008;14:445e452)Key Words: Cardiovascular disease, thiazolidinediones, left ventricular dysfunction.