The diabetes drug Avandia is under fire: What you should know
Diabetics taking Avandia to control their blood glucose are in a fix. An analysis of 42 studies that was published last week in the New England Journal of Medicine found that for such patients, the risk of heart attack was 43 percent higher than for those not taking the drug. The authors suggested a few possible reasons, such as Avandia's tendency to raise the level of LDL cholesterol, the bad variety, but made it clear that they didn't know. U.S. News asked University of Washington internist Bruce Psaty, coauthor of a companion editorial, to help diabetics decipher the findings.
How significant is an increase of 43 percent in heart-attack risk?
It's a substantially higher risk. Think about it this way-when we use lipid-lowering drugs like statins, we expect to reduce the risk of heart attack by 20 to 40 percent. So there's as much of an adverse effect from Avandia as there is a beneficial effect from statins.
What if I'm taking this drug?
If you have questions about continuing, you should talk with your doctor about the risks and benefitsdon't try to be your own physician.
What's your own opinion of Avandia?
I have never prescribed this drug. There was early evidence of weight gain and lipid problems, and it was hard for me to see how this would play out.
Are there other options?
The most effective treatments for diabetes are weight loss and exercise. They improve lipids, blood pressure, and even mood. There are other drugs, and of course there is insulin.
Actos is a similar drug. Is there a reason for those on it to worry?
We need more information. It's clear that Actos is associated with an increased risk of heart failure. The evidence for increased risk of heart attack doesn't seem to be there, but to my knowledge, there hasn't been a complete review of the evidence.
Is there some way to know if I'm one of the patients who might have a problem?
We just know there's a concern about cardiovascular problems. We lack sufficiently robust information to be able to identify people at higher risk.
Should the Food and Drug Administration take Avandia off the market?
I am not aware of data the FDA and the company may know about. But I don't know of a reason for physicians to prescribe it.
This story appears in the June 4, 2007 print edition of U.S. News & World Report.