Thiazolidinediones (TZDs) may reduce the risk for atrial fibrillation (AF) in patients with diabetes, according to a study published in BMC Cardiovascular Disorders.
Diabetes is a significant predictor for developing incident AF and for poor outcomes in patients with AF, such as AF recurrence after cardioversion, stroke, and death. Data suggest that the link between AF and diabetes may be driven by inflammation and oxidative stress. TZDs reduce peripheral insulin resistance and also exert antioxidant and anti-inflammatory effects that may lower the risk for AF, although data supporting this hypothesis are limited and conflicting.
Researchers, led by Tong Liu, MD, PhD and Zhiwei Zhang, BS, from the Tianjin Institute of Cardiology in China, examined whether TZDs reduced the risk for AF in patients with diabetes in a meta-analysis of the current evidence.
A total of 130,854 patients from 4 observational studies and 3 randomized clinical trials (RCTs) were included in this study.
Compared with control treatment, TZDs reduced the risk of AF by 30% (odds ratio [OR], 0.73; 95% CI, 0.62-0.87; P =.0003) in the analysis of pooled data from all 7 studies. While this observation was replicated in separate pooled analyses of the 4 observational studies and the 3 RCTs, the relationship was significant only for the pooled observational studies.
Similarly, TZD use significantly decreased the risk for new-onset AF (OR, 0.77; 95% CI, 0.65-0.91; P =.002) and recurrent AF (OR, 0.41; 95% CI, 0.24-0.72; P =.002).
While pioglitazone and rosiglitazone use both lowered AF risk, the risk reduction was significant for pioglitazone (OR, 0.56; 95% CI, 0.32-0.98; P =.04) but not rosiglitazone (OR, 0.78; 95% CI, 0.57-1.07; P =.12).
In an interview with Cardiology Advisor, Dr Liu noted that the protective effect of TZDs on AF incidence and recurrence was largely driven by observational data. “Thus, the results should be interpreted with caution,” he said. “Further large-scale RCTs are needed to determine whether TZD use could prevent AF in the setting of [diabetes].”
Zhang Z, Zhang X, Korantzopoulos P, et al. Thiazolidinedione use and atrial fibrillation in diabetic patients: a meta-analysis. BMC Cardiovasc Disord. 2017;17(1):96. doi:10.1186/s12872-017-0531-4