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Pioglitazone: an agent which reduces stroke, myocardial infarction and death and is also a key component of the modern paradigm for the optimum management of type 2 diabetes
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| Zeitschriftentitel: | The British Journal of Diabetes & Vascular Disease |
|---|---|
| Personen und Körperschaften: | |
| In: | The British Journal of Diabetes & Vascular Disease, 11, 2011, 3, S. 113-120 |
| Format: | E-Article |
| Sprache: | Englisch |
| veröffentlicht: |
SAGE Publications
|
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Ryder, R.E.J. Ryder, R.E.J. |
|---|---|
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Ryder, R.E.J. |
| spellingShingle |
Ryder, R.E.J. The British Journal of Diabetes & Vascular Disease Pioglitazone: an agent which reduces stroke, myocardial infarction and death and is also a key component of the modern paradigm for the optimum management of type 2 diabetes Cardiology and Cardiovascular Medicine Endocrinology, Diabetes and Metabolism Internal Medicine |
| author_sort |
ryder, r.e.j. |
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Ryder, R.E.J. 1474-6514 1753-4305 SAGE Publications Cardiology and Cardiovascular Medicine Endocrinology, Diabetes and Metabolism Internal Medicine http://dx.doi.org/10.1177/1474651411412658 <jats:p> A randomised controlled trial (RCT), the PROactive study, was undertaken to see if pioglitazone improved cardiovascular outcomes in type 2 diabetes. Initially the results were controversial and pioglitazone was not widely recognised as a beneficial agent for cardiovascular disease. A meta-analysis of rosiglitazone studies raising the possibility that it was associated with cardiovascular harm received worldwide media attention and the negative concern spread to involve pioglitazone through presumed ‘class-effect’. A careful re-look at the detail of the PROactive’s primary composite endpoint, which led to the controversy over the outcome, suggests that medical statistics may have been inadequate to reveal the real clinical effect. A number of other studies support the interpretation that pioglitazone significantly improves cardiovascular outcomes. While the potential risk:benefit of pioglitazone needs to be acknowledged, it now also needs to be recognised that pioglitazone and metformin are the only glucose-lowering agents with RCT data demonstrating a reduction in stroke, myocardial infarction and death in type 2 diabetes. Furthermore there now exists a strong case that even in type 2 diabetes patients without known cardiovascular disease, the modern paradigm for management should involve the combination of metformin, pioglitazone and glucagon-like peptide 1 agonists used early and aggressively to achieve a target glycated haemoglobin A<jats:sub>1C</jats:sub> <6%. </jats:p> Pioglitazone: an agent which reduces stroke, myocardial infarction and death and is also a key component of the modern paradigm for the optimum management of type 2 diabetes The British Journal of Diabetes & Vascular Disease |
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Pioglitazone: an agent which reduces stroke, myocardial infarction and death and is also a key component of the modern paradigm for the optimum management of type 2 diabetes |
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Pioglitazone: an agent which reduces stroke, myocardial infarction and death and is also a key component of the modern paradigm for the optimum management of type 2 diabetes |
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Pioglitazone: an agent which reduces stroke, myocardial infarction and death and is also a key component of the modern paradigm for the optimum management of type 2 diabetes |
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Pioglitazone: an agent which reduces stroke, myocardial infarction and death and is also a key component of the modern paradigm for the optimum management of type 2 diabetes |
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pioglitazone: an agent which reduces stroke, myocardial infarction and death and is also a key component of the modern paradigm for the optimum management of type 2 diabetes |
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Cardiology and Cardiovascular Medicine Endocrinology, Diabetes and Metabolism Internal Medicine |
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<jats:p> A randomised controlled trial (RCT), the PROactive study, was undertaken to see if pioglitazone improved cardiovascular outcomes in type 2 diabetes. Initially the results were controversial and pioglitazone was not widely recognised as a beneficial agent for cardiovascular disease. A meta-analysis of rosiglitazone studies raising the possibility that it was associated with cardiovascular harm received worldwide media attention and the negative concern spread to involve pioglitazone through presumed ‘class-effect’. A careful re-look at the detail of the PROactive’s primary composite endpoint, which led to the controversy over the outcome, suggests that medical statistics may have been inadequate to reveal the real clinical effect. A number of other studies support the interpretation that pioglitazone significantly improves cardiovascular outcomes. While the potential risk:benefit of pioglitazone needs to be acknowledged, it now also needs to be recognised that pioglitazone and metformin are the only glucose-lowering agents with RCT data demonstrating a reduction in stroke, myocardial infarction and death in type 2 diabetes. Furthermore there now exists a strong case that even in type 2 diabetes patients without known cardiovascular disease, the modern paradigm for management should involve the combination of metformin, pioglitazone and glucagon-like peptide 1 agonists used early and aggressively to achieve a target glycated haemoglobin A<jats:sub>1C</jats:sub> <6%. </jats:p> |
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| description | <jats:p> A randomised controlled trial (RCT), the PROactive study, was undertaken to see if pioglitazone improved cardiovascular outcomes in type 2 diabetes. Initially the results were controversial and pioglitazone was not widely recognised as a beneficial agent for cardiovascular disease. A meta-analysis of rosiglitazone studies raising the possibility that it was associated with cardiovascular harm received worldwide media attention and the negative concern spread to involve pioglitazone through presumed ‘class-effect’. A careful re-look at the detail of the PROactive’s primary composite endpoint, which led to the controversy over the outcome, suggests that medical statistics may have been inadequate to reveal the real clinical effect. A number of other studies support the interpretation that pioglitazone significantly improves cardiovascular outcomes. While the potential risk:benefit of pioglitazone needs to be acknowledged, it now also needs to be recognised that pioglitazone and metformin are the only glucose-lowering agents with RCT data demonstrating a reduction in stroke, myocardial infarction and death in type 2 diabetes. Furthermore there now exists a strong case that even in type 2 diabetes patients without known cardiovascular disease, the modern paradigm for management should involve the combination of metformin, pioglitazone and glucagon-like peptide 1 agonists used early and aggressively to achieve a target glycated haemoglobin A<jats:sub>1C</jats:sub> <6%. </jats:p> |
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| spelling | Ryder, R.E.J. 1474-6514 1753-4305 SAGE Publications Cardiology and Cardiovascular Medicine Endocrinology, Diabetes and Metabolism Internal Medicine http://dx.doi.org/10.1177/1474651411412658 <jats:p> A randomised controlled trial (RCT), the PROactive study, was undertaken to see if pioglitazone improved cardiovascular outcomes in type 2 diabetes. Initially the results were controversial and pioglitazone was not widely recognised as a beneficial agent for cardiovascular disease. A meta-analysis of rosiglitazone studies raising the possibility that it was associated with cardiovascular harm received worldwide media attention and the negative concern spread to involve pioglitazone through presumed ‘class-effect’. A careful re-look at the detail of the PROactive’s primary composite endpoint, which led to the controversy over the outcome, suggests that medical statistics may have been inadequate to reveal the real clinical effect. A number of other studies support the interpretation that pioglitazone significantly improves cardiovascular outcomes. While the potential risk:benefit of pioglitazone needs to be acknowledged, it now also needs to be recognised that pioglitazone and metformin are the only glucose-lowering agents with RCT data demonstrating a reduction in stroke, myocardial infarction and death in type 2 diabetes. Furthermore there now exists a strong case that even in type 2 diabetes patients without known cardiovascular disease, the modern paradigm for management should involve the combination of metformin, pioglitazone and glucagon-like peptide 1 agonists used early and aggressively to achieve a target glycated haemoglobin A<jats:sub>1C</jats:sub> <6%. </jats:p> Pioglitazone: an agent which reduces stroke, myocardial infarction and death and is also a key component of the modern paradigm for the optimum management of type 2 diabetes The British Journal of Diabetes & Vascular Disease |
| spellingShingle | Ryder, R.E.J., The British Journal of Diabetes & Vascular Disease, Pioglitazone: an agent which reduces stroke, myocardial infarction and death and is also a key component of the modern paradigm for the optimum management of type 2 diabetes, Cardiology and Cardiovascular Medicine, Endocrinology, Diabetes and Metabolism, Internal Medicine |
| title | Pioglitazone: an agent which reduces stroke, myocardial infarction and death and is also a key component of the modern paradigm for the optimum management of type 2 diabetes |
| title_full | Pioglitazone: an agent which reduces stroke, myocardial infarction and death and is also a key component of the modern paradigm for the optimum management of type 2 diabetes |
| title_fullStr | Pioglitazone: an agent which reduces stroke, myocardial infarction and death and is also a key component of the modern paradigm for the optimum management of type 2 diabetes |
| title_full_unstemmed | Pioglitazone: an agent which reduces stroke, myocardial infarction and death and is also a key component of the modern paradigm for the optimum management of type 2 diabetes |
| title_short | Pioglitazone: an agent which reduces stroke, myocardial infarction and death and is also a key component of the modern paradigm for the optimum management of type 2 diabetes |
| title_sort | pioglitazone: an agent which reduces stroke, myocardial infarction and death and is also a key component of the modern paradigm for the optimum management of type 2 diabetes |
| title_unstemmed | Pioglitazone: an agent which reduces stroke, myocardial infarction and death and is also a key component of the modern paradigm for the optimum management of type 2 diabetes |
| topic | Cardiology and Cardiovascular Medicine, Endocrinology, Diabetes and Metabolism, Internal Medicine |
| url | http://dx.doi.org/10.1177/1474651411412658 |