Reassessing the Risk-Benefit Profile of Thiazolidinediones: Cardiovascular Risks and Stroke Prevention Through Real-World Data
Authors' conclusion
Our analysis shows that pioglitazone has potential therapeutic effects on stroke prevention and fewer cardiovascular adverse events compared to rosiglitazone, underscoring the importance of reassessing TZD safety for optimal patient outcomes.
Study context
- Population
- FAERS reports (January 2004 to December 2023) for thiazolidinediones (TZDs); clinical studies (January 2000 to March 2024) in individuals with diabetes and prediabetes
- Comparison
- Pioglitazone vs rosiglitazone
- Outcome
- Cardiovascular risks of TZDs (MI, HF, stroke) and efficacy in stroke prevention
Methodological detailsreal-world data, multivariable logistic regression-adjusted reporting OR, SUCRA rankings
- Real-world data
- Multivariable logistic regression-adjusted reporting OR
- SUCRA rankings
Pooled result
As reported in the abstract
Cardiovascular risks (FAERS)
- Significantly higher cardiovascular risks associated with TZDs
- Rosiglitazone linked to markedly increased incidence of MI, heart failure (HF) and stroke
- No strong cardiovascular risks with pioglitazone; slightly heightened risk of HF
Further pooled results
Stroke (network meta-analysis)
- vs placebo, rosiglitazone increased stroke risk, pioglitazone reduced stroke incidence in diabetes and prediabetes
- SUCRA rankings and ranking probabilities
Original publication
Reassessing the Risk-Benefit Profile of Thiazolidinediones: Cardiovascular Risks and Stroke Prevention Through Real-World Data. Endocr Pract. Published 15 April 2025. doi:10.
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