Cardiovascular risk-benefit ratio of thiazolidinediones

The insulin-sensitizing thiazolidinediones (TZDs) are effective antihyperglycemic agents for patients with type 2 diabetes mellitus (T2DM). Early research has suggested they hold promise for mitigating some of the negative cardiovascular implications of insulin resistance. Although these drugs, in addition to lowering glucose, improve lipid profiles, reduce blood pressure, enhance endothelial function, and appear to have a beneficial impact on various surrogates of atherosclerosis, their effect on actual cardiovascular outcomes is less clear. Importantly, any benefit on cardiovascular events may be offset to some degree by fluid retention and a small increased risk of heart failure. Possible differential clinical effects between the two available members of this class have further contributed to the debate. We review these issues in the context of the overall cardiovascular risk-benefit ratio of the TZDs in patients with T2DM. © 2009 Current Medicine Group LLC.