Thiazolidinedione-associated congestive heart failure and pulmonary edema

Mayo Clin Proc. 2003 Sep;78(9):1088-91. doi: 10.4065/78.9.1088.


Objective: To evaluate the effect of thiazolidinediones on the development of cardiac failure and pulmonary edema during treatment of type 2 diabetes mellitus.

Patients and methods: We retrospectively reviewed the medical records of 6 men (aged 66 to 78 years) treated at our institution between August 1, 2001, and May 21, 2002, who had type 2 diabetes and developed signs and symptoms of congestive heart failure and pulmonary edema after 1 to 16 months of therapy with pioglitazone or rosiglitazone.

Results: Four patients had chronic renal insufficiency; only 1 had ischemic cardiomyopathy. Symptoms resolved promptly in all 6 patients after administration of diuretics and discontinuation of the thiazolidinedione.

Conclusion: We conclude that thiazolidinediones can cause or exacerbate heart failure and pulmonary edema and should be avoided in patients with left ventricular dysfunction or chronic renal insufficiency.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Cardiomyopathies / complications
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Heart Failure / chemically induced*
  • Humans
  • Hypoglycemic Agents / adverse effects*
  • Kidney Failure, Chronic / complications
  • Male
  • Myocardial Ischemia / complications
  • Pulmonary Edema / chemically induced*
  • Retrospective Studies
  • Thiazoles / adverse effects*
  • Thiazolidinediones*


  • Hypoglycemic Agents
  • Thiazoles
  • Thiazolidinediones
  • 2,4-thiazolidinedione