The statement will also be published in the January issue of Diabetes Care.
Diabetes is a major risk factor for heart disease. TZD agents rosiglitizone maleate (Avandia) and pioglitazone hydrochloride (Actos) help doctors manage patients' glucose (blood sugar) levels and may even modify other heart disease risk factors such as high blood pressure, high cholesterol and inflammation, said Richard W. Nesto, M.D., chair of the department of cardiovascular medicine at the Lahey Clinic in Burlington, Mass., and lead author of the joint statement.
"There is now widespread use of TZDs in a broad group of patients with type 2 diabetes. At the same time there have been reports of congestive heart failure associated with their use," Nesto said.
In some people, the drugs are associated with fluid retention known as edema, especially swelling of the feet. Edema may also be a hallmark of congestive heart failure.
"It is sometimes difficult to know whether such swelling is a benign side effect of the drugs or a more ominous sign of heart failure," Nesto said. "It is this common association that concerns both cardiologists and diabetologists."
The joint writing group examined existing studies to identify patients with diabetes who are at increased risk for congestive heart failure and may not be ideal candidates for the thiazolidinedione class of drugs. "This gives us a way to manage risk," Nesto said. It also helps physicians and patients balance potential risk against "an otherwise excellent class of drugs that can improve glycemic control."