Comments on: Avandia and heart attacks http://www.kevinmd.com/blog/2007/05/avandia-and-heart-attacks.html medical blog Sun, 22 Nov 2009 14:15:05 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: daedalus2u http://www.kevinmd.com/blog/2007/05/avandia-and-heart-attacks.html/comment-page-1#comment-75322 daedalus2u Tue, 22 May 2007 11:11:00 +0000 http://clients.emmense.com/kevinmd/2007/05/avandia-and-heart-attacks.html#comment-75322 In my opinion, it is unconscionable that the only endpoint the FDA used to approve it was blood glucose level. In my opinion, it is unconscionable that the only endpoint the FDA used to approve it was blood glucose level.

]]> By: Megan http://www.kevinmd.com/blog/2007/05/avandia-and-heart-attacks.html/comment-page-1#comment-75318 Megan Tue, 22 May 2007 04:38:00 +0000 http://clients.emmense.com/kevinmd/2007/05/avandia-and-heart-attacks.html#comment-75318 I think I would rather take insulin than a drug that's going to cause me to have an MI, especially when diabetes already puts you at great risk for heart disease. Granted, it was just one study. I suppose as a type 1 diabetic who has never taken anything but insulin, I'm a little biased on the subject. However, as a medical professional I do feel that with insulin available, there's really no situation in which the benefit of an oral medication with significant, well documented, side effects outweighs the benefits of said medication. Insulin has very few side effects if proper hypoglycemia education is done. <br/><br/>I know insulin shouldn't be the first line treatment for type 2, but it sure seems to make more sense than MIs. I think I would rather take insulin than a drug that’s going to cause me to have an MI, especially when diabetes already puts you at great risk for heart disease. Granted, it was just one study. I suppose as a type 1 diabetic who has never taken anything but insulin, I’m a little biased on the subject. However, as a medical professional I do feel that with insulin available, there’s really no situation in which the benefit of an oral medication with significant, well documented, side effects outweighs the benefits of said medication. Insulin has very few side effects if proper hypoglycemia education is done.

I know insulin shouldn’t be the first line treatment for type 2, but it sure seems to make more sense than MIs.

]]> By: daedalus2u http://www.kevinmd.com/blog/2007/05/avandia-and-heart-attacks.html/comment-page-1#comment-75303 daedalus2u Mon, 21 May 2007 21:15:00 +0000 http://clients.emmense.com/kevinmd/2007/05/avandia-and-heart-attacks.html#comment-75303 The "killer ap" for Rosiglitazone is the metabolic syndrome. It is not clear if it is good for patients with underlying heart conditions.<br/><br/>http://care.diabetesjournals.org/cgi/content/full/27/1/256<br/><br/>My own opinion, is that the risk is real, and that treating the symptoms of hyperglycemia and insulin resistance is the wrong approach. <br/><br/>The tissue compartment where glucose and insulin concentrations matter most is in the extravascular space, far from the vessel wall, where obviously it is lower than in the blood vessel (due to consumption by intervening cells). <br/><br/>I appreciate that such measurements are difficult (and non-standard), but extravascular fluid is what most cells are in contact with, not bulk blood. <br/><br/>I suspect that hyperglycemia results from a shift in ATP production from oxidative phosphorylation to glycolysis, and it takes 19 times more glucose to supply the same ATP from glycolysis as from oxidative phosphorylation. Shifting 5% of ATP from oxidative phosphorylation to glycolysis would double glucose requirements. Glucose transport into cells is active, only through GLUT transporters. How much more glucose can the vasculature supply? The “killer ap” for Rosiglitazone is the metabolic syndrome. It is not clear if it is good for patients with underlying heart conditions.

http://care.diabetesjournals.org/cgi/content/full/27/1/256

My own opinion, is that the risk is real, and that treating the symptoms of hyperglycemia and insulin resistance is the wrong approach.

The tissue compartment where glucose and insulin concentrations matter most is in the extravascular space, far from the vessel wall, where obviously it is lower than in the blood vessel (due to consumption by intervening cells).

I appreciate that such measurements are difficult (and non-standard), but extravascular fluid is what most cells are in contact with, not bulk blood.

I suspect that hyperglycemia results from a shift in ATP production from oxidative phosphorylation to glycolysis, and it takes 19 times more glucose to supply the same ATP from glycolysis as from oxidative phosphorylation. Shifting 5% of ATP from oxidative phosphorylation to glycolysis would double glucose requirements. Glucose transport into cells is active, only through GLUT transporters. How much more glucose can the vasculature supply?

]]> By: RJS http://www.kevinmd.com/blog/2007/05/avandia-and-heart-attacks.html/comment-page-1#comment-75300 RJS Mon, 21 May 2007 19:49:00 +0000 http://clients.emmense.com/kevinmd/2007/05/avandia-and-heart-attacks.html#comment-75300 TZDs seem to show promise in inhibiting angiogenesis in certain tumors as well increasing the efficacy of certain types of chemotherapy in some types of cancer patients. (In a rush, otherwise I'd get you source links.)<br/><br/>I don't think we'll see either of the two major TZD players go anywhere. They're just too interesting. TZDs seem to show promise in inhibiting angiogenesis in certain tumors as well increasing the efficacy of certain types of chemotherapy in some types of cancer patients. (In a rush, otherwise I’d get you source links.)

I don’t think we’ll see either of the two major TZD players go anywhere. They’re just too interesting.

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