Thiazide Use and Cardiovascular Events in Type 2 Diabetic Patients With Well-Controlled Blood Pressure

Thiazide-associated hyponatremia increases the risk of major adverse cardiovascular events among elderly Taiwanese patients

BACKGROUND

Thiazide-associated hyponatremia (TAH) has been supposed to increase the risk of major adverse cardiovascular events (MACE) in the elderly. Therefore, this study aimed to evaluate the association of TAH with the risk of MACE in elderly Taiwanese patients.

METHODS

Data from the longitudinal generation tracking database (LGTD 2010) of the Health and Welfare Data Science Center (HWDC) were retrospectively assessed. The TAH study group was defined as using > 30 cumulative daily defined doses (CDDDs) thiazide diuretics within one year before diagnosis of hyponatremia. The control group (1:3 propensity score matching) had no diagnosis of hyponatremia but had used > 30 CDDDs thiazide diuretics within one year. Data on MACE were extracted using International Classification of Diseases codes. Outcomes were assessed using a multivariable Cox proportional hazard model and Kaplan-Meier analysis.

RESULTS

A total of 1155 and 3465 individuals were enrolled in the TAH and the control groups, respectively. The rates of MACE (11.1% vs. 7.3%) and death (22.8% vs.12.2%) were significantly higher in the TAH group than the control group. In the TAH group, the adjusted HRs were 1.29 (CI 1.01 ‒ 1.65) for MACE, 1.39 (CI 1.19 ‒ 1.63) for all-cause death, and 1.61 (CI 0.90 ‒ 2.92) for stroke.

CONCLUSION

TAH in patients above 65-years-old is associated with a 29% higher risk of MACE, 39% higher risk of all-cause death, and 61% higher risk of stroke. This work suggests that thiazides prescription in elderly patients should be more careful. However, further research is required to confirm our findings.

The effects of chronic hypoxia on the endocrine-related parameters in elderly rats with type 2 diabetes mellitus

OBJECTIVE

This study aimed to investigate the effects of chronic hypoxia on the endocrine-related parameters in elderly rats with type 2 diabetes mellitus.

METHODS

Sixty, 55-week-old, female SD rats were studied, among which 20 were randomly divided into a blank control group (the BCG), and 40 were intraperitoneally injected with low-dose streptozotocin (STZ) for modeling and divided into a model control group (the MCG, n=20) and a hypoxic group (the HG, n=20). The BCG and the MCG were fed routinely under normoxia, while the HG was fed in the hypoxic environment of an OxyCycler Model A84XO hypoxic chamber. After 12 weeks of intervention, the body weights, the fasting blood glucose (FBG) levels, the fasting insulin (FINS) levels, the blood lipid metabolism levels, the bone densities, the fresh weights of the femurs, the biomechanical properties of the femurs, the inflammatory factor levels, the H&E staining of the liver tissue, and the oil red O staining were compared.

RESULTS

The increases in weight gain and the FBG and FINS levels in the HG were lower than the corresponding levels in the MCG and were higher than the levels in the BCG (P<0.05). The TC, TG, and LDL-C levels in the HG were lower than they were in the MCG and higher than they were in the BCG (P<0.05). The bone density and fresh weight of the femurs at 12 weeks after the intervention in the HG were higher than they were in the MCG and lower than they were in the BCG (P<0.05). The maximum stress, maximum load, fracture load, and elastic modulus in the HG were higher than they were in the MCG and lower than they were in the BCG (P<0.05). The TNF-α, IL-6, PAI-1, and CRP levels in the HG were lower than they were in the MCG and higher than they were in the BCG (P<0.05).

CONCLUSION

Chronic hypoxia can improve the endocrine parameters and insulin resistance, improve the insulin sensitivity and the femoral biomechanics, reduce the inflammatory factors levels, and improve the glucose and lipid metabolism levels and liver function in elderly rats with type 2 diabetes.

Thiazide Exposure and Cardiovascular Risk in Type 2 Diabetes Mellitus: A Point of Clarification

A recently published analysis in Hypertension suggests that thiazide use, versus nonuse, is associated with excess risk of adverse cardiovascular outcomes in patients with diabetes mellitus enrolled in the ACCORD trial (Action to Control Cardiovascular Risk in Diabetes). Here, we replicate these findings using the same publicly available datasets and following their reported methods. We further show that possible misclassification of thiazide exposure exists in the original analysis. We perform alternative analyses that correct for this misclassification to highlight the impact that misclassification can have on observed associations between an exposure (eg, thiazides) and outcomes (eg, stroke and major adverse cardiovascular events).