Jazet Ingrid M, Meinders A Edo
Leids Universitair Medisch Centrum, afd. Endocrinologie en Metabolisme/Algemene Interne Geneeskunde, Leiden, The Netherlands.
Ned Tijdschr Geneeskd. 2009;153:A942.
Several meta-analyses imply that rosiglitazone increases the risk of myocardial infarction. However, the studies included were small and not designed to study the effect on cardiovascular risk. The Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of glycaemia in Diabetes study (RECORD) was specifically designed to assess the effect of rosiglitazone on cardiovascular outcomes. After a mean follow-up of 5.5 years, the study showed no increase in cardiovascular hospitalisation or cardiovascular mortality with rosiglitazone and either metformin or sulphonylurea versus metformin/sulphonylurea combination therapy. There was a non-significant increase in myocardial infarction with rosiglitazone, but this did not result in increased mortality rates. Moreover, the Bypass Angioplasty revascularisation Investigation 2 Diabetes study (BARI 2D) showed no increase in myocardial infarction or cardiovascular death in type 2 diabetic patients with coronary disease who received insulin-sensitising therapy including rosiglitazone. Therefore, rosiglitazone can be prescribed as long as the indications are followed and the patients concerned do not have heart failure or an increased risk for this.
多项荟萃分析表明罗格列酮会增加心肌梗死风险。然而，纳入的研究规模较小，并非旨在研究其对心血管风险的影响。罗格列酮对糖尿病心脏转归和血糖调节的评估研究（RECORD研究）专门设计用于评估罗格列酮对心血管转归的影响。经过平均5.5年的随访，该研究表明，与二甲双胍/磺脲类联合治疗相比，罗格列酮与二甲双胍或磺脲类联合使用时，心血管住院率或心血管死亡率并未增加。罗格列酮治疗组心肌梗死有非显著性增加，但这并未导致死亡率上升。此外，糖尿病患者血管成形术血运重建研究2（BARI 2D研究）表明，接受包括罗格列酮在内的胰岛素增敏治疗的2型冠心病糖尿病患者，心肌梗死或心血管死亡并未增加。因此，只要遵循适应证且相关患者没有心力衰竭或心力衰竭风险增加，就可以开具罗格列酮处方。
