Detecting Pioglitazone Use and Risk of Cardiovascular Events Using Electronic Health Record Data in a Large Cohort of Chinese Patients with Type 2 Diabetes.

BACKGROUND: Pioglitazone may have a protective effect on cardiovascular disease risk among type 2 diabetes patients but evidence from China is lacking. Our study aimed to investigate the association using massive electronic health records data from a Chinese cohort of type 2 diabetes patients.

METHODS: All T2DM patients from the First Affiliated Hospital of Nanjing Medical University in China who were prescribed at least one oral antidiabetic drug and aged >=18 between July 1, 2005 and June 30, 2017 were eligible for the study (n=71,783). Pioglitazone use was determined in six-month study intervals, the outcome events were myocardial infarction, ischemic stroke and heart failure. Poisson regression was used to estimate adjusted rate ratios with 95% confidence intervals.

RESULTS: In multivariable analysis adjusted for potential confounders, pioglitazone use compared with no use was associated with a significant 39% decreased risk of myocardial infarction (RR=0.61; 95% CI = 0.42-0.90; P=0.012). Pioglitazone use was also associated with a non-significant reduction in risk of heart failure or stroke. When myocardial infarction, heart failure, and stroke were combined as a composite outcome, pioglitazone use was associated with a 30% decreased risk (RR=0.70; 95% CI = 0.56-0.88; P=0.002).

CONCLUSIONS: Our study demonstrated that applying informatics tools to large Electronic Health Records(EHR) data could serve as an essential way to efficiently conduct clinical observational research. Also, our findings validated the favorable effect of pioglitazone on the risk of myocardial infarction among type 2 diabetes patients in China, pioglitazone use decreased risks of MI among T2DM. This article is protected by copyright. All rights reserved.