Heart failure after thiazolidinedione therapy

Hippokratia 2005, 9(2):87-91

Ch Sambanis, K Tziomalos, E Kehagia, E Nakou, E Randou, E Kountana, T Didangelos, D Karamitsos
2nd Propedeutic Dpt Internal Medicine, Hippokratio General Hospital, Thessaloniki, Greece


Background. Thiazolidinediones are a group of hypoglycemic agents that enhance insulin sensitivity and improve glycemic control in patients with type 2 diabetes. Their main side effect is fluid retention, which might lead to congestive heart failure. The aim of this study was to report the clinical characteristics of nine patients with type 2 diabetes who developed heart failure after the administration of thiazolidinediones.
Methods. Nine patients with type 2 diabetes (six females), with a mean age of 71.7 years (range 63-82 years), who were receiving thiazolidinediones (6 of them rosiglitazone and 3 pioglitazone), were included in this study.
Results. All patients were admitted in our Department because of symptoms and signs of heart failure (3 manifested acute pulmonary edema and six worsening heart failure). All patients had experienced weight gain (range 2.5-7 kg), peripheral edema, exertional dyspnea and one of them unstable angina. These signs and symptoms developed at a median time of 1,9 months (range 1-3 months) after the initiation of thiazolidinedione treatment. Eight patients had coronary heart disease (documented by their history and ECG), three had a history of pulmonary edema, eight were hypertensive, five were receiving loop diuretics and two were receiving insulin. Therapy for heart failure was provided and thiazolidinediones were discontinued. All patients showed a decrease in body weight, and edema and dyspnea resolved rapidly.
Conclusions. Administration of. thiazolidinediones is associated with an increased risk of development of heart failure in patients with type 2 diabetes who often have multiple risk factors for heart failure. Heart function should be carefully evaluated prior to the initiation of thiazolidinedione treatment and patients should be closely monitored, particularly during the first three months of treatment.