Thiazolidinedione Use and Cardiovascular Outcomes in Patients With Type 2 Diabetes Who Underwent Carotid Artery Revascularization

BACKGROUND: Thiazolidinediones are oral antidiabetic agents known for their wide-ranging pleiotropic effects, potentially offering cardiovascular protection. Using a nationwide health claims database in Korea, we evaluated whether thiazolidinedione treatment was associated with long-term cardiovascular prognosis after carotid revascularization. METHODS AND RESULTS: This retrospective cohort study included patients with type 2 diabetes who underwent carotid endarterectomy or stent insertion in Korea between 2009 and 2020. The use of medications, including thiazolidinediones, was determined from prescription records, identifying exposure to medications within 30 days following carotid revascularization. The primary outcome was the composite occurrence of stroke, myocardial infarction, and all-cause death following carotid revascularization. A multivariate Cox regression analysis was conducted to assess the primary outcomes. The cohort included 14 220 patients with type 2 diabetes who underwent carotid revascularization (2669 via carotid endarterectomy and 11 551 via carotid stent insertion). Among them, 1034 patients received thiazolidinedione treatment. Over a mean follow-up period of 4.13±3.14 years, 4087 patients experienced a primary outcome. Thiazolidinedione treatment was significantly associated with a reduced risk of primary outcomes (adjusted hazard ratio [HR], 0.81 [95% CI, 0.71–0.93]; P=0.002). The protective effect of thiazolidinediones was supported in a propensity score–matched analysis comparing thiazolidinedione users with nonusers (HR, 0.81 [95% CI, 0.68–0.95]; P=0.013). CONCLUSIONS: Thiazolidinedione treatment following carotid revascularization was associated with favorable cardiovascular outcomes in patients with type 2 diabetes. Further research is needed to explore the cardioprotective roles of thiazolidinediones in this high-risk group.