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Thiazolidinedione use and atrial fibrillation in diabetic patients: a meta-analysis

View Article: PubMed Central - PubMed

ABSTRACT

Background: Accumulating evidence suggests that thiazolidinediones (TZDs) may exert protective effects in atrial fibrillation (AF). The present meta-analysis investigated the association between TZD use and the incidence of AF in diabetic patients.

Methods: Electronic databases were searched until December 2016. Of the 346 initially identified records, 3 randomized clinical trials (RCTs) and 4 observational studies with 130,854 diabetic patients were included in the final analysis.

Results: Pooled analysis of the included studies demonstrated that patients treated with TZDs had approximately 30% lower risk of developing AF compared to controls [odds ratio (OR): 0.73, 95% confidence interval (CI): 0.62 to 0.87, p = 0.0003]. This association was consistently observed for both new onset AF (OR =0.77, p = 0.002) and recurrent AF (OR =0.41, p = 0.002), pioglitazone use (OR =0.56, p = 0.04) but not rosiglitazone use (OR =0.78, p = 0.12). The association between TZD use and AF incidence was not significant in the pooled analysis of three RCTs (OR =0.77, 95% CI = 0.53–1.12, p = 0.17), but was significantly in the pooled analysis of the four observational studies (OR =0.71, p = 0.0003).

Conclusions: This meta-analysis suggests that TZDs may confer protection against AF in the setting of diabetes mellitus (DM). This class of drugs can be used as upstream therapy for DM patients to prevent the development of AF. Further large-scale RCTs are needed to determine whether TZDs use could prevent AF in the setting of DM.

No MeSH data available.


Funnel plot of meta-analysis
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Fig3: Funnel plot of meta-analysis

Mentions: The present meta-analysis has potential limitations. Firstly, due to the small number of included studies we analyzed observational studies and RCTs together while 2 included RCTs reported AF as an adverse event rather than a predefined endpoint, and the favorable effects of TZDs use on preventing AF incidence were predominately driven by observational studies, whereas data from the 2 RCTs were unable to draw unanimous conclusion. Secondly, information regarding methods of AF detection, cardiac substrate, ejection fraction and atrial volume were not fully presented in our analysis due to the lack of relative data. Thirdly, the heterogeneous types of patient populations (ranging from uncomplicated type 2 diabetics to post-CABG or post-AF ablation patients) may indicate latent bias in this meta-analysis. Fourthly, “gray” literature (primarily conference abstracts/presentations, ongoing studies, communication with investigators) was not searched. Finally, the results of the funnel plot suggested that publication bias may be present, although the small number of studies made this somewhat difficult to interpret (Fig. 3).Fig. 3


Thiazolidinedione use and atrial fibrillation in diabetic patients: a meta-analysis
Funnel plot of meta-analysis
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5382449&req=5

Fig3: Funnel plot of meta-analysis
Mentions: The present meta-analysis has potential limitations. Firstly, due to the small number of included studies we analyzed observational studies and RCTs together while 2 included RCTs reported AF as an adverse event rather than a predefined endpoint, and the favorable effects of TZDs use on preventing AF incidence were predominately driven by observational studies, whereas data from the 2 RCTs were unable to draw unanimous conclusion. Secondly, information regarding methods of AF detection, cardiac substrate, ejection fraction and atrial volume were not fully presented in our analysis due to the lack of relative data. Thirdly, the heterogeneous types of patient populations (ranging from uncomplicated type 2 diabetics to post-CABG or post-AF ablation patients) may indicate latent bias in this meta-analysis. Fourthly, “gray” literature (primarily conference abstracts/presentations, ongoing studies, communication with investigators) was not searched. Finally, the results of the funnel plot suggested that publication bias may be present, although the small number of studies made this somewhat difficult to interpret (Fig. 3).Fig. 3

View Article: PubMed Central - PubMed

ABSTRACT

Background: Accumulating evidence suggests that thiazolidinediones (TZDs) may exert protective effects in atrial fibrillation (AF). The present meta-analysis investigated the association between TZD use and the incidence of AF in diabetic patients.

Methods: Electronic databases were searched until December 2016. Of the 346 initially identified records, 3 randomized clinical trials (RCTs) and 4 observational studies with 130,854 diabetic patients were included in the final analysis.

Results: Pooled analysis of the included studies demonstrated that patients treated with TZDs had approximately 30% lower risk of developing AF compared to controls [odds ratio (OR): 0.73, 95% confidence interval (CI): 0.62 to 0.87, p = 0.0003]. This association was consistently observed for both new onset AF (OR =0.77, p = 0.002) and recurrent AF (OR =0.41, p = 0.002), pioglitazone use (OR =0.56, p = 0.04) but not rosiglitazone use (OR =0.78, p = 0.12). The association between TZD use and AF incidence was not significant in the pooled analysis of three RCTs (OR =0.77, 95% CI = 0.53–1.12, p = 0.17), but was significantly in the pooled analysis of the four observational studies (OR =0.71, p = 0.0003).

Conclusions: This meta-analysis suggests that TZDs may confer protection against AF in the setting of diabetes mellitus (DM). This class of drugs can be used as upstream therapy for DM patients to prevent the development of AF. Further large-scale RCTs are needed to determine whether TZDs use could prevent AF in the setting of DM.

No MeSH data available.