Rosiglitazone and Cardiovascular Outcomes

Diabetes mellitus is a common chronic disease that is characterized and defined by an elevated glucose level and that has grown in prevalence by 75% in the United States during a 20-year period ending in 2010.1 The exact reason for this rising prevalence is not known with certainty; however, a large body of evidence implicates changes in weight, caloric consumption, reduced physical activity, and migration to urban versus rural dwellings. Regardless of the reasons for this growth, epidemiological studies and analyses of administrative databases have repeatedly shown that people with diabetes mellitus are 2 to 3 times more likely to experience fatal and nonfatal cardiovascular outcomes than people without diabetes mellitus.2 This high risk was the basis for the intentional inclusion of ambulatory adults with diabetes mellitus in a large number of recent cardiovascular outcomes trials that either recruited large subpopulations or people with diabetes mellitus or were wholly restricted to people with diabetes mellitus. These trials showed that therapies that were shown to be cardioprotective in people without diabetes mellitus will also reduce cardiovascular outcomes in ambulatory people with diabetes mellitus. These include blood pressure lowering,3 low-density lipoprotein lowering with statins,4 angiotensin-converting enzyme inhibitors5 or angiotensin receptor blockers,6 and bypass surgery.7 During the same period, other therapies were shown to have a neutral effect on cardiovascular outcomes in people with diabetes mellitus, including vitamin E,8 omega 3 fatty acids,9 and basal insulin.10Article see p 785Implementation of the results of these trials may account for the decline in absolute risk of cardiovascular outcomes and death in people with diabetes mellitus over time.11,12 However, both the inability of these trials to reduce this risk to levels seen in people without diabetes mellitus6 and the inability …