Glitazone Not Contraindicated in Diabetics With
Heart Failure
There appears to be no direct connection between
thiazolidinedione-related fluid retention and cardiac
dysfunction in diabetic patients with chronic heart
failure.
That from researchers in a report in the April
16th issue of the Journal of the American
College of Cardiology.
As lead investigator Dr. W. H. Wilson Tang told
Reuters Health, these agents "are very effective in
preventing 'resistance' to insulin, thus improving
vascular function. However, there have been significant
concerns over their propensity to cause fluid retention."
The development of fluid retention "naturally
translates into the belief that thiazolidinediones
may directly cause heart failure--or there is a direct
association between impaired heart function with
a higher likelihood of developing fluid retention."
To investigate, Dr. Tang and colleagues at
the Cleveland Clinic Foundation in Ohio examined
data on 111 diabetic
patients with chronic systolic heart failure
who were treated with a glitazone over a
period of
about 30 months. Comparable subjects not
using thiazolidinediones
acted as controls.
In all, 19 of the treatment group (17.1%),
most of whom were women and insulin users,
developed
fluid
retention, which was reversed after drug
withdrawal. The retention predominantly
took the form of
peripheral, but not central, edema.
Furthermore, no direct association was
seen between the risk of fluid retention
and the
baseline
degree of severity of heart failure.
Thus Dr. Tang continued, "it is very important
to distinguish between 'fluid retention' and 'heart
failure,' and those patients who develop fluid retention
may not be predicted by our standard quantitative
measures of heart failure severity."
"
Although one out of five patients with chronic heart
failure developed some degree of weight gain and
signs of worsening fluid retention after starting
thiazolidinediones," he concluded, "the
rest of the patients tolerated [them] well." J
Am Coll Cardiol 2003;41:1394-1398.
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