Primary cardiovascular preventive effect of thiazolidinedione in adults with type 2 diabetes: A nationwide cohort study in Korea

Abstract

Background Thiazolidinediones (TZDs) are antidiabetic agents recognized for their effectiveness in secondary cardiovascular prevention; however, their role in primary prevention remains uncertain. This study evaluated the primary cardiovascular preventive effect of TZDs in patients with type 2 diabetes mellitus (T2DM).Methods Using the nationwide health claims database, we conducted a cohort study including 1,958,643 adults with T2DM and no prior history of cardiovascular disease. TZD users were compared with dipeptidyl peptidase-4 inhibitor (DPP-4i) users as active comparators. After 1:1 propensity score matching (PSM), major cardiovascular events-composite of myocardial infarction (MI), stroke, hospitalization for heart failure (HF), and all-cause mortality-were compared using Cox proportional hazards models.Results In the PSM cohort consisting of 47,536 TZD users and 47,536 DPP-4i users, TZD users were associated with a lower risk of major cardiovascular events (HR 0.85, 95% CI 0.82-0.88). TZD users had lower risks of MI (HR 0.72, 95% CI 0.64-0.82), stroke (HR 0.84, 95% CI 0.78-0.90), and all-cause mortality (HR 0.86, 95% CI 0.82-0.90), with no difference in HF hospitalizations.Conclusions TZD use was associated with a reduced risk of major cardiovascular events in T2DM patients, suggesting a potential role of TZDs in primary cardiovascular prevention.