Is rosiglitazone use associated with an increase in intensive eye treatment in diabetic patients? A community based study.

OBJECTIVE: To evaluate the effect of rosiglitazone on diabetic retinopathy in the usual care setting. METHODS: Type 2 diabetic patients, aged over 40, who received rosiglitazone therapy for at least one year during the study period, were considered for the study group. All diabetic patients who had never received rosiglitazone or insulin were candidates for the control group. For each subject treated with rosiglitazone, up to five controls were randomly selected and matched on age, gender, and HbA1c%. We retrieved information about ophthalmologist visits, retinal argon laser therapy, vitrectomy and the date of the procedure. Time from the first rosiglitazone prescription to the first intervention was calculated. RESULTS: A total of 6689 subjects, 1304 in the rosiglitazone group and 5385 in the control group were followed for a median of 3.6 years. The baseline level of HbA1C% was slightly higher in the rosiglitazone group (9.2 versus 8.8). There were more ophthalmologist visits in the rosiglitazone group compared to the control group. 115/1304 (8.8%) patients in the study group had an event compared to 379/5385 (7.0%) control group (P = 0.027). HR for the study group was 1.3 (95% CI: 1.08-1.64) for any event compared to control group (P = 0.008). CONCLUSION: Rosiglitazone was associated with increased laser treatments and vitrectomy. Caution may be needed when treating diabetic patients with rosiglitazone.

Statin administration and risk of cholecystectomy: a population-based case-control study.

BACKGROUND: Gallstone disease is common in Western countries. Statins reduce biliary cholesterol secretion and have anti-inflammatory effects, suggesting that they may play a role in reducing the incidence of surgically treated gallstone disease. AIM: To examine a potential association between statin administration and risk of cholecystectomy. METHODS: We conducted a population-based case-control study of surgically treated gallstone disease using the database of Clalit Health Services (CHS). The study population consisted of all individuals age 40 - 85 enrolled with the central region of CHS during the period 1 January 2000 to 31 December 2006. We identified patients who underwent cholecystectomy between 1 January 2003 and 31 December 2006 (n = 1465). Controls (n = 5860) were individually matched on year of birth and sex in a 4:1 ratio. Multivariable conditional logistic regression models to compute the odds ratio of cholecystectomy associated with statin therapy were constructed to control for patients' clinical and socio-demographic characteristics. RESULTS: Statin use with at least 80% adherence to treatment was associated with about 30% reduction in the risk of cholecystectomy (adjusted odds ratio 0.69; 95% CI 0.57 - 0.84). CONCLUSION: The results of our large population-based study suggest that the use of statins reduces the risk of surgery for gallstone disease.

Achieving target cholesterol levels in diabetic patients: potency of the statin or potency of the physician?

BACKGROUND: The introduction of more potent statins such as atorvastatin and rosuvastatin in Israel was accompanied by massive advertising about their superiority. OBJECTIVES: To assess the need for switching therapy from older statins to more potent ones among diabetic patients with uncontrolled hypercholesterolemia. METHODS: Data on all diabetic patients over 30 years old attending two urban clinics were extracted and analyzed. For each patient we checked the last low density lipoprotein-cholesterol measurements for the year 2006, the brand and the dose of cholesterol-lowering medications, prescriptions and actual purchasing over a 4 month period prior to the last LDL-C measurement, and whether treatment changes were necessary to achieve the LDL-C target (100 mg/dl or 70 mg/dl). RESULTS: The study population comprised 630 patients, age 66.7 +/- 12.6 years, of whom 338 (53.6%) were women. Of the 533 (84.6%) patients whose LDL-C was measured in 2006, 45 (8.1%) had levels <70 mg/dl and 184 (33.3%) had levels of 70 mg/dl < LDL-C < 100 m/dl. The reasons for LDL-C > 100 mg/dl were patients not prescribed cholesterol-lowering drugs (38.3%), partial compliance (27.2%), and under-dosage of statins (15.4%); only 7.7% needed to switch to a more potent statin. Reasons for LDL-C > 70 mg/dl were patients not prescribed cholesterol-lowering drugs (34.3%), partial compliance (22.0%), and under-dosage of statins (26.6%); only 8.7% needed to switch to a more potent statin. CONCLUSIONS: Only a small minority of diabetic patients with uncontrolled hypercholesterolemia need one of the potent statins as the next treatment step. More emphasis on compliance and dose adjustment is needed to achieve the target LDL-C level.