In fact, RECORD had several problems that prevented it from proving that rosiglitazone does not elevate the risk of myocardial infarction (MI, or heart attack). These were:

1. Possibly because RECORD was an “open-label,” rather than a double-blind trial, patients in the rosiglitazone group received different co-interventions than patients in the control group. In particular, about 10% more patients in the rosiglitazone group (55.2% vs 46.0%) were receiving statins at the end of the trial than were patients in the control group. There is pretty good evidence that statins reduce the risk of coronary artery disease, and hence, of MIs. Thus, thiis version of co-intervention bias may have decreased the apparent rate of MIs in the rosiglitazone group.

2. The RECORD trial suffered from a significant loss to follow-up. For 8.9% of patients, ascertainment of cardiovascular outcomes was incomplete. Since the rate of MIs in the whole group was less than 3% over 6 years of observation, it is possible that had all these cardiovascular outcomes been ascertained, the ratio of MIs in the rosiglitazone and control groups would have turned out quite differently, either indicating less, or more risk due to rosiglitazone.

3. The RECORD trial was too small to prove that rosiglitazone did not raise MI risk, possibly substantially. The 95% confidence interval for the risk of MI due to rosiglitazone was (0.80, 1.63). A somewhat crude way to interpret this is that the chances of rosiglitazone causing a risk of MI higher than 1.63 was less than 5%. On the other hand, the trial could not disprove that rosiglitazone raised the risk of MI by as much as 1.63 times. (Note that the point estimate of risk of MI was 1.14, meaning that the best guess of the effect of rosiglitazone on MI risk was that it raised it by 1.14 times, or 14%)

Furthermore, the trial showed that rosiglitazone substantially raised the risk of congestive heart failure (although there had not been much previous controversy about this adverse effect).

Thus, I believe you were wrong in saying that rosiglitazone was not associated with cardiovascular risks. Moreover, I believe Dr Mintz’s rant about an Avandia “scare” harming patients was not justified by the evidence provided by RECORD. Furthermore, I think his call for an investigation of Dr Nissen, the New England Journal of Medicine, and the FDA vis a vis rosiglitazone is way over the top.

I’d asked about RECORD a few posts back because of the likelyhood of having to make a decision in a year or two. My impression from reading 3rd hand reports paralleled Dr. Pho’s conclusion – which is personally helpful to me. I have a minor indication to avoid metformin, so Avandia and similar medicines might be a better choice – and I now know to discount the inevitable horror stories when they come up.

I only wish there was a way Dr. Pho could earn money out of this service he has provided

Dr Mintz seemed very favorably inclined towards Avandia, and was pretty harsh in his discussion of Dr Nissen.

So, maybe Dr Mintz ought to have disclosed his financial ties to GSK, the maker of Avandia, for example, see:
http://cme.medscape.com/viewprogram/6294,
an educational program supported by a grant from GSK,
and click on “authors and disclosures” to see that Dr Mintz has served on an advisory board and the speakers’ bureau of GSK.