As Dr Erqou points out, we did carefully differentiate between trials with high thiazolidinedione (TZD) use and those without. In addition, we highlighted the potential “off-target” effects of TZDs.1 However, to fully explore the relationship between intensity of glucose lowering and development of heart failure, it is important to include the TZD trials, while carefully recognizing potential confounding. Of course, we agree that our findings are far from conclusive (and stated this) and that further studies are needed to better understand the puzzling disconnect between the epidemiologic data and those from randomized clinical trials. Dr Erqou also states that the results of the observational study from the Diabetes Registry of the Kaiser Permanente Medical Care Program2 and our findings are consistent. We disagree. The studies address different questions. Iribarren et al investigated the association between glycated hemoglobin levels and heart failure incidence in a large population of adults with diabetes, whereas our meta-analysis sought to determine whether improved glycemic control reduces this risk. Several other differences concerning the adjudication of heart failure events, the duration of follow-up, and the information about antidiabetic drugs used make it impossible to compare these 2 studies.
Reply to the letter by Dr Erqou regarding “Intensive glycemic control has no impact on the risk of heart failure in type 2 diabetic patients”
CASTAGNO, Davide;GAITA, Fiorenzo;
2012-01-01
Abstract
As Dr Erqou points out, we did carefully differentiate between trials with high thiazolidinedione (TZD) use and those without. In addition, we highlighted the potential “off-target” effects of TZDs.1 However, to fully explore the relationship between intensity of glucose lowering and development of heart failure, it is important to include the TZD trials, while carefully recognizing potential confounding. Of course, we agree that our findings are far from conclusive (and stated this) and that further studies are needed to better understand the puzzling disconnect between the epidemiologic data and those from randomized clinical trials. Dr Erqou also states that the results of the observational study from the Diabetes Registry of the Kaiser Permanente Medical Care Program2 and our findings are consistent. We disagree. The studies address different questions. Iribarren et al investigated the association between glycated hemoglobin levels and heart failure incidence in a large population of adults with diabetes, whereas our meta-analysis sought to determine whether improved glycemic control reduces this risk. Several other differences concerning the adjudication of heart failure events, the duration of follow-up, and the information about antidiabetic drugs used make it impossible to compare these 2 studies.
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