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Whittington Health NHSUCL

Does the 'glitazone' family increase the risk of heart problems?

The glitazones are a family of medicines used to treat type 2 diabetes. For some time, they have been associated with heart problems and this is why rosiglitazone has been withdrawn.

Research is ongoing about other members of the glitazone family.

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When glitazones (such as rosiglitazone and pioglitazone) were first introduced, it was hoped that they might reduce the risk of heart and vessel problems such as heart attacks and heart failure.

This was because they had some encouraging features. For instance, they were associated with slightly better healthy cholesterol (HDL) levels and seemed to have a positive effect on blood pressure.

However, concerns became increasingly apparent, particularly in terms of heart failure and fluid accumulation in the legs and the lungs.

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Rosiglitazone became available in July 2000. It was soon noticed that rosiglitazone could worsen fluid accumulation in the lungs (pulmonary oedema) and legs (ankle oedema). Because of this, its use was restricted to patients without heart failure.

A European-wide review of the risks and benefits of rosiglitazone was performed in September 2010.

Rosiglitazone was found to increase the risk of heart-related problems including heart attack, thereby causing avoidable deaths. As a result, doctors were advised to stop prescribing rosiglitazone and the medicine was gradually phased out.

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Pioglitazone is in the same family as rosiglitazone but this does not necessarily mean that it has the same risks.

There is no doubt that pioglitazone can worsen fluid accumulation. As a result, it should not be used in people with heart failure. However, unlike rosiglitazone, pioglitazone does not seem to increase the risk of heart attacks or death.

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At the moment, pioglitazone can be considered in appropriately selected people, but should not be used without trying other medications first.

People taking piolgitazone should be reviewed regularly and the medicine should only be continued if it is clearly helping control diabetes.