Thiazolidinedione use and atrial fibrillation in diabetic patients: a meta-analysis

Zhang, Zhiwei; Zhang, Xiaowei; Korantzopoulos, Panagiotis; Letsas, Κonstantinos P.; Tse, Gary; Gong, Mengqi; Meng, Lei; Li, Guangping; Liu, Tong

doi:10.1186/s12872-017-0531-4

Cited by 77 publications

(65 citation statements)

References 41 publications

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“…17 Furthermore, a meta-analysis of the insulin sensitizing thiazolidines (TZDs) showed an overall reduction in the risk of developing AF of 30%. 18 In a prospective observational study, the TZD pioglitazone was shown to significantly reduce the recurrence of AF following catheter ablation in patients with paroxysmal AF and T2DM. 18,19 Therefore, the major risk factor for developing AF in the diabetic patient is not hyperglycaemia, but rather, the metabolic syndrome (MS) with its main components obesity and hypertension.…”

Section: Incidence and Frequency Of Atrial Fibrillation In The Typementioning

confidence: 99%

“…The association of the coincidence of hypertension and diabetes remained significant when adjusted for other cardiovascular risk factors, including BMI, but lost significance when adjusted for insulin resistance which was assessed by the HOMA method . Furthermore, a meta‐analysis of the insulin sensitizing thiazolidines (TZDs) showed an overall reduction in the risk of developing AF of 30% . In a prospective observational study, the TZD pioglitazone was shown to significantly reduce the recurrence of AF following catheter ablation in patients with paroxysmal AF and T2DM …”

Section: Incidence and Frequency Of Atrial Fibrillation In The Type 2mentioning

confidence: 99%

“…Furthermore, a meta‐analysis of the insulin sensitizing thiazolidines (TZDs) showed an overall reduction in the risk of developing AF of 30% . In a prospective observational study, the TZD pioglitazone was shown to significantly reduce the recurrence of AF following catheter ablation in patients with paroxysmal AF and T2DM …”

Section: Incidence and Frequency Of Atrial Fibrillation In The Type 2mentioning

confidence: 99%

“…Recurrent AF (OR, 0.41; P = 0.002) was reduced with use of pioglitazone (OR, 0.56; P = 0.04) but not with use of rosiglitazone (OR, 0.78; P = 0.12). The association between TZD use and AF incidence was not significant in the pooled analysis of three RCTs but was significant in the pooled analysis of the four observational studies …”

Section: Effect Of Drugs Used To Treat Type 2 Diabetes On Atrial Fibrmentioning

confidence: 99%

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Atrial fibrillation and type 2 diabetes: Prevalence, etiology, pathophysiology and effect of anti‐diabetic therapies

Bell

Goncalves

2018

Diabetes Obesity Metabolism

111

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New-onset atrial fibrillation (NAF) is increased in the type 2 diabetic patient because of the presence of the metaboli syndrome and increased sympathetic activity. This results in inflammation, endothelial dysfunction and myocardial steatosis which, in turn, lead to atrial fibrosis and dilatation. The end result is the development of structural and electrical atrial remodeling. Drugs that lower insulin resistance, particularly pioglitazone, decrease the incidence of NAF while drugs that, through hypoglycaemia, stimulate the sympathetic nervous system, insulin and secretagogues, increase the incidence of NAF. Currently there is no evidence that GLP-1 agonists, SGLT2 inhibitors and DPP-4 inhibitors either accelerate or decelerate the development of NAF.

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Section: Incidence and Frequency Of Atrial Fibrillation In The Typementioning

confidence: 99%

Section: Incidence and Frequency Of Atrial Fibrillation In The Type 2mentioning

confidence: 99%

Section: Incidence and Frequency Of Atrial Fibrillation In The Type 2mentioning

confidence: 99%

Section: Effect Of Drugs Used To Treat Type 2 Diabetes On Atrial Fibrmentioning

confidence: 99%

See 2 more Smart Citations

Atrial fibrillation and type 2 diabetes: Prevalence, etiology, pathophysiology and effect of anti‐diabetic therapies

Bell

Goncalves

2018

Diabetes Obesity Metabolism

111

View full text Add to dashboard Cite

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“…In observational studies, the use of pioglitazone in patients with diabetes is associated with a lower risk for new‐onset or recurrent AF . Furthermore, pioglitazone and rosiglitazone alleviate ventricular fibrosis and diastolic filling abnormalities and minimize the development of experimental HFpEF, even if weight increases because of increased adipogenesis; accordingly, the use of thiazolidinediones has been associated with improvements in abnormal diastolic filling dynamics in patients with diabetes …”

Section: Therapeutic Challenges In Patients With a Metabolic Disordermentioning

confidence: 99%

Do most patients with obesity or type 2 diabetes, and atrial fibrillation, also have undiagnosed heart failure? A critical conceptual framework for understanding mechanisms and improving diagnosis and treatment

Packer

2019

European J of Heart Fail

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Obesity and diabetes can lead to heart failure with preserved ejection fraction (HFpEF), potentially because they both cause expansion and inflammation of epicardial adipose tissue and thus lead to microvascular dysfunction and fibrosis of the underlying left ventricle. The same process also causes an atrial myopathy, which is clinically evident as atrial fibrillation (AF); thus, AF may be the first manifestation of HFpEF. Many patients with apparently isolated AF have latent HFpEF or subsequently develop HFpEF. Most patients with obesity or diabetes who have AF and exercise intolerance have increased left atrial pressures at rest or during exercise, even in the absence of diagnosed HFpEF. Among patients with AF, those who also have latent HFpEF have increased risk for systemic thromboembolism and death. The identification of HFpEF in patients with obesity or diabetes alters the risk‐to‐benefit relationship of commonly prescribed treatments. Bariatric surgery and statins can ameliorate AF and reduce the risk for HFpEF. Conversely, antihyperglycaemic drugs that promote adipogenesis or cause sodium retention (insulin and thiazolidinediones) may increase the risk for heart failure in patients with an underlying ventricular myopathy. Patients with obesity and diabetes who undergo catheter ablation for AF are at increased risk for AF recurrence and for post‐ablation increases in pulmonary venous pressures and worsening heart failure, especially if HFpEF coexists. Therefore, AF may be the earliest indicator of HFpEF in patients with obesity or type 2 diabetes, and recognition of HFpEF alters the management of these patients.

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Treatment Effects in Randomized and Nonrandomized Studies of Pharmacological Interventions

Salcher-Konrad,

Nguyen,

Savović

et al. 2024

JAMA Netw Open

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ImportanceRandomized clinical trials (RCTs) are widely regarded as the methodological benchmark for assessing clinical efficacy and safety of health interventions. There is growing interest in using nonrandomized studies to assess efficacy and safety of new drugs.ObjectiveTo determine how treatment effects for the same drug compare when evaluated in nonrandomized vs randomized studies.Data SourcesMeta-analyses published between 2009 and 2018 were identified in MEDLINE via PubMed and the Cochrane Database of Systematic Reviews. Data analysis was conducted from October 2019 to July 2024.Study SelectionMeta-analyses of pharmacological interventions were eligible for inclusion if both randomized and nonrandomized studies contributed to a single meta-analytic estimate.Data Extraction and SynthesisFor this meta-analysis using a meta-epidemiological framework, separate summary effect size estimates were calculated for nonrandomized and randomized studies within each meta-analysis using a random-effects model and then these estimates were compared. The reporting of this study followed the Guidelines for Reporting Meta-Epidemiological Methodology Research and relevant portions of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline.Main Outcome and MeasuresThe primary outcome was discrepancies in treatment effects obtained from nonrandomized and randomized studies, as measured by the proportion of meta-analyses where the 2 study types disagreed about the direction or magnitude of effect, disagreed beyond chance about the effect size estimate, and the summary ratio of odds ratios (ROR) obtained from nonrandomized vs randomized studies combined across all meta-analyses.ResultsA total of 346 meta-analyses with 2746 studies were included. Statistical conclusions about drug benefits and harms were different for 130 of 346 meta-analyses (37.6%) when focusing solely on either nonrandomized or randomized studies. Disagreements were beyond chance for 54 meta-analyses (15.6%). Across all meta-analyses, there was no strong evidence of consistent differences in treatment effects obtained from nonrandomized vs randomized studies (summary ROR, 0.95; 95% credible interval [CrI], 0.89-1.02). Compared with experimental nonrandomized studies, randomized studies produced on average a 19% smaller treatment effect (ROR, 0.81; 95% CrI, 0.68-0.97). There was increased heterogeneity in effect size estimates obtained from nonrandomized compared with randomized studies.Conclusions and RelevanceIn this meta-analysis of treatment effects of pharmacological interventions obtained from randomized and nonrandomized studies, there was no overall difference in effect size estimates between study types on average, but nonrandomized studies both overestimated and underestimated treatment effects observed in randomized studies and introduced additional uncertainty. These findings suggest that relying on nonrandomized studies as substitutes for RCTs may introduce additional uncertainty about the therapeutic effects of new drugs.

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Thiazolidinedione use and atrial fibrillation in diabetic patients: a meta-analysis

Cited by 77 publications

References 41 publications

Atrial fibrillation and type 2 diabetes: Prevalence, etiology, pathophysiology and effect of anti‐diabetic therapies

Atrial fibrillation and type 2 diabetes: Prevalence, etiology, pathophysiology and effect of anti‐diabetic therapies

Do most patients with obesity or type 2 diabetes, and atrial fibrillation, also have undiagnosed heart failure? A critical conceptual framework for understanding mechanisms and improving diagnosis and treatment

Treatment Effects in Randomized and Nonrandomized Studies of Pharmacological Interventions

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