PMID- 37100230
OWN - NLM
STAT- MEDLINE
DCOM- 20230606
LR  - 20230606
IS  - 1872-8227 (Electronic)
IS  - 0168-8227 (Linking)
VI  - 200
DP  - 2023 Jun
TI  - Pioglitazone, SGLT2 inhibitors and their combination for primary prevention of 
      cardiovascular disease and heart failure in type 2 diabetes: Real-world evidence 
      from a nationwide cohort database.
PG  - 110685
LID - S0168-8227(23)00446-1 [pii]
LID - 10.1016/j.diabres.2023.110685 [doi]
AB  - OBJECTIVE: To evaluate the effect of SGLT2is, pioglitazone, and their combination 
      on the risk of major adverse cardiovascular events (MACE) and heart failure in 
      type 2 diabetes mellitus (T2DM) patients without a history of cardiovascular 
      disease. RESEARCH DESIGN AND METHODS: Using Taiwan National Health Insurance 
      Research Database, we identified four groups based on medication use, including 
      1) both SGLT2is and pioglitazone, 2) SGLT2i, 3) pioglitazone and 4) non-study 
      drugs (reference group). The four groups were matched by propensity score. The 
      primary outcome was 3-point MACE, which included myocardial infarction, stroke, 
      cardiovascular death, and the secondary outcome was incidence of heart failure. 
      RESULTS: After propensity-matching, each group included 15,601 patients. Compared 
      with the reference group, the pioglitazone/SGLT2i combination group had a 
      significantly lower risk for MACE (aHR 0.76, 95 % CI 0.66-0.88) and heart failure 
      (aHR 0.67, 95 % CI 0.55-0.82). Pioglitazone was associated with a lower risk of 
      MACE (aHR 0.82, 95 % CI 0.71-0.94) and there was no difference in risk of heart 
      failure compared with the reference group. The incidence of heart failure was 
      significantly decreased in the SGLT2i group (aHR 0.7, 95 % CI 0.58-0.86). 
      CONCLUSION: Combination therapy with pioglitazone and SGLT2is is an effective 
      treatment in the primary prevention of MACE and heart failure in patients with 
      type 2 diabetes.
CI  - Copyright (c) 2023 Elsevier B.V. All rights reserved.
FAU - Lo, Shih-Chang
AU  - Lo SC
AD  - Institute of Medicine of Chung Shan Medical University, Taiwan; Chung Shan 
      Medical University Hospital, Department of Internal Medicine, Division of 
      Endocrinology and Metabolism, Taiwan. Electronic address: shihchanglo@gmail.com.
FAU - Kornelius, Edy
AU  - Kornelius E
AD  - Chung Shan Medical University Hospital, Department of Internal Medicine, Division 
      of Endocrinology and Metabolism, Taiwan; School of Medicine of Chung Shan Medical 
      University, Taiwan. Electronic address: korn3lius82@gmail.com.
FAU - Liao, Pei-Lun
AU  - Liao PL
AD  - Chung Shan Medical University Hospital, Department of Medical Research, Taiwan. 
      Electronic address: liaopeilun0410@gmail.com.
FAU - Huang, Jing-Yang
AU  - Huang JY
AD  - Institute of Medicine of Chung Shan Medical University, Taiwan; Chung Shan 
      Medical University Hospital, Department of Medical Research, Taiwan. Electronic 
      address: wchinyang@gmail.com.
FAU - Yang, Yi-Sun
AU  - Yang YS
AD  - Chung Shan Medical University Hospital, Department of Internal Medicine, Division 
      of Endocrinology and Metabolism, Taiwan; School of Medicine of Chung Shan Medical 
      University, Taiwan. Electronic address: monica119@gmail.com.
FAU - Huang, Chien-Ning
AU  - Huang CN
AD  - Institute of Medicine of Chung Shan Medical University, Taiwan; Chung Shan 
      Medical University Hospital, Department of Internal Medicine, Division of 
      Endocrinology and Metabolism, Taiwan; School of Medicine of Chung Shan Medical 
      University, Taiwan. Electronic address: cshy049@gmail.com.
LA  - eng
PT  - Journal Article
DEP - 20230424
PL  - Ireland
TA  - Diabetes Res Clin Pract
JT  - Diabetes research and clinical practice
JID - 8508335
RN  - X4OV71U42S (Pioglitazone)
RN  - 0 (Sodium-Glucose Transporter 2 Inhibitors)
RN  - 0 (Hypoglycemic Agents)
SB  - IM
MH  - Humans
MH  - Pioglitazone/therapeutic use
MH  - *Diabetes Mellitus, Type 2/complications/drug therapy/chemically induced
MH  - *Cardiovascular Diseases/epidemiology/etiology/prevention & control
MH  - *Sodium-Glucose Transporter 2 Inhibitors/therapeutic use
MH  - Hypoglycemic Agents/therapeutic use
MH  - *Heart Failure/drug therapy/epidemiology/prevention & control
MH  - Primary Prevention
OTO - NOTNLM
OT  - Cardiovascular disease
OT  - SGLT2 inhibitors
OT  - Thiazolidinedione
OT  - Type 2 diabetes
COIS- Declaration of Competing Interest The authors declare that they have no known 
      competing financial interests or personal relationships that could have appeared 
      to influence the work reported in this paper.
EDAT- 2023/04/27 00:42
MHDA- 2023/06/06 06:42
CRDT- 2023/04/26 19:27
PHST- 2023/01/11 00:00 [received]
PHST- 2023/04/09 00:00 [revised]
PHST- 2023/04/19 00:00 [accepted]
PHST- 2023/06/06 06:42 [medline]
PHST- 2023/04/27 00:42 [pubmed]
PHST- 2023/04/26 19:27 [entrez]
AID - S0168-8227(23)00446-1 [pii]
AID - 10.1016/j.diabres.2023.110685 [doi]
PST - ppublish
SO  - Diabetes Res Clin Pract. 2023 Jun;200:110685. doi: 10.1016/j.diabres.2023.110685. 
      Epub 2023 Apr 24.