Review: Thiazolidinediones in patients with type 2 diabetes mellitus and heart failure.

In this article, the authors review the significant findings related to the use of thiazolidinediones (TZDs) in the treatment of patients with type 2 diabetes mellitus and heart failure. They cover the following areas:

• Benefits of TZDs on cardiovascular surrogate endpoints
• Weight gain
• Oedema
• Heart failure
• Observational studies
• Prospective clinical trial (PROactive)

The authors note that ‘because of the potential for fluid retention and worsening oedema, clinical studies have excluded patients with New York Heart Association (NYHA) functional class III or IV heart failure. In patients at risk for heart failure or those who have NYHA functional class I or II symptoms, initiation of therapy should be at the lower dose for TZDs with close monitoring of weight gain, oedema, and other signs of worsening heart failure … patients with NYHA functional class III or IV heart failure should not receive TZDs’.

Am J Health Syst Pharm 2007; 64: 931-6 (link to abstract)