The web site logo

Just released: Thiazolidinedione Drugs and Cardiovascular Risks A Science Advisory From the American Heart Association and American College of Cardiology Foundation Sanjay Kaul, MD, FAHA, FACC, Chair; Ann F. Bolger, MD, FAHA, FACC; David Herrington, MD, MHS, FAHA, FACC; Robert P. Giugliano, MD, ScM, FACC; Robert H. Eckel, MD, FAHA   Circulation. 2010;121:1868-1877. 

Keys to Patient Management

The following are keys to patient management:
• Identification and treatment of correctable risk factors
– Smoking cessation
– High-quality diet
– Weight control
– Exercise

• Use of established secondary prevention strategies
– Aspirin (or clopidogrel in patients intolerant of aspirin)
– Lipid lowering, with statins as the first-line therapy
– Blood pressure lowering

• Early and consistent attention to controlling hyperglycemia while avoiding hypoglycemia
– Metformin is generally first-line therapy, particularly in obese patients

– Thiazolidinediones should not be used with an expectation of benefit with respect to IHD events
– Insufficient data exist to support the choice of pioglitazone over rosiglitazone
– Thiazolidinediones increase the risk of heart failure and should not be initiated in patients with class III/IV CHF