Diabetes Drugs and Heart Risk
New Studies Link Avandia, but Not Actos, to Heart Attacks
GSK Disputes Avandia Findings continued...
"The evidence confirms a significantly increased risk of heart attack with [Avandia] and a doubling in the risk of heart failure compared to other oral [blood sugar-reducing] agents," Singh tells WebMD. "We are waiting for clinical trial evidence suggesting that [Avandia] use leads to a reduction in the morbidity and mortality in patients with type 2 diabetes. Until such evidence becomes available, we stand by our statement that [Avandia] should not be used in diabetic patients at risk for cardiovascular events."
Clinical trials have not yet demonstrated a clear survival benefit or reduction in diabetes complications for patients taking Avandia. But they do show that Avandia helps people with diabetes control their blood sugar.
"We know from clinical studies that effective treatment of diabetes requires intensive, long-term, day-to-day control of blood sugar levels to reduce the risk of serious complications (such as blindness, kidney failure, limb amputation, nerve injury) and ultimately save lives," the GSK statement says. "Avandia is the most widely studied oral medication for type 2 diabetes, and is an important option for physicians who often need to prescribe several different diabetes medicines in combination to help their patients maintain blood sugar control."
Study: Actos Has Heart Attack-Stroke Benefit, Not Risk
The second JAMA study analyzes clinical trial data on Actos. It comes from Cleveland Clinic researchers A. Michael Lincoff, MD, and colleagues -- including Nissen.
The study shows that Actos does not increase risk of heart attack but instead reduces diabetes patients' risk of heart attack, stroke, and death by 18%.
"We can say with confidence that Actos not only does not have the risk seen with Avandia, but has a benefit beyond that," Lincoff tells WebMD. "I am a cardiologist, not a diabetologist. But if a drug of this class is thought to be a good drug for a diabetic patient, Actos has benefit beyond its blood sugar and insulin-resistance indications for reducing death and heart attack and stroke; all reduced about 20%."
An editorial accompanying the studies notes that the two drugs have "strikingly different" effects on heart attack risk. Editorialist Daniel H. Solomon, MD, PhD, is associate professor of medicine at Harvard Medical School and a rheumatologist in the division of pharmacoepidemiology at Brigham and Women's Hospital, Boston.