Abstract Number: Esoc2026a573 Primary Cardiovascular Preventive Effect of Thiazolidinedione in Adults With Type 2 Diabetes: A Nationwide Cohort Study in Korea

Abstract Background and aims Type 2 diabetes mellitus (T2DM) is strongly associated with increased cardiovascular disease (CVD) risk. Thiazolidinediones (TZDs) are anti-diabetic agents effective in secondary cardiovascular prevention; however, their role in primary prevention remains uncertain. This study evaluated the effectiveness of TZDs, specifically pioglitazone and lobeglitazone, in reducing major cardiovascular events in patients with T2DM without prior CVD. Methods Using the South Korean National Health Insurance Service database, we conducted a retrospective nationwide cohort study including 1,970,670 adults with T2DM and no history of myocardial infarction (MI) or stroke. TZD users were compared with dipeptidyl peptidase- 4 inhibitor (DPP-4i) users as active comparators. After 1:1 propensity score matching (PSM), major cardiovascular events– composite of MI, stroke, hospitalization for heart failure (HF), and all-cause mortality – were compared using Cox proportional hazards models to estimate hazard ratios (HR). Results In the PSM cohort consisting of 47,558 TZD users and 47,558 DPP-4i users, TZD users were associated with a lower risk of major cardiovascular events (HR 0.83, 95% CI 0.80–0.86). Both pioglitazone (HR 0.84, 95% CI 0.81–0.87) and lobeglitazone (HR 0.78, 95% CI 0.73–0.83) conferred cardiovascular benefits. TZD users had lower risks of MI (HR 0.74, 95% CI 0.66–0.84), stroke (HR 0.85, 95% CI 0.79–0.91), and all-cause mortality (HR 0.83, 95% CI 0.79–0.87), with no difference in HF hospitalizations. Conclusions In this large nationwide cohort, TZD use was associated with a reduced risk of major cardiovascular events in T2DM patients, suggesting a potential role of TZDs in primary cardiovascular prevention. Conflict of interest Jinkwon Kim reports research grants from Chong Kun Dang Pharmaceutical and Myung In Pharm. Co., Ltd. Minyoul Baik reports research grants from Daewoong and HK inno. N Pharmaceuticals. Yun Young Choi, Joonsang Yoo and Jimin Jeon have nothing to disclose. Figure 1 - belongs to Methods Figure 2 - belongs to Results