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Thiazolidinediones are oral medications for type 2 diabetes that include Avandia (rosiglitazone) and Actos (pioglitazone), or those drugs in combination with other types of medication, such as Avandaryl (rosiglitazone and glimepiride), Avandamet (rosiglitazone and metformin), and Duetact (pioglitazone and glimepiride).gt;gt;This relatively new class of drug helps combat insulin resistance by making your body more sensitive to insulin. The first thiazolidinedione was approved for sale in the U.S. in 1997. It was sold under the brand name Rezulin (troglitazone), but was pulled from the market in March 2000 due to the risk for severe liver problems.gt;gt;Avandia and Actos were approved by the U.S. Food and Drug Administration in 1999. gt;gt;In 2007, a gt;studygt; suggested that Avandia was associated with an increased risk of heart attack and heart failure, a condition in which the heart becomes enlarged and pumps inefficiently. Shortly after, another gt;studygt; found that Actos also boosted the risk of heart failure, although it reduced the risk of heart attack, stroke and death overall. Both studies were widely covered in the news.gt;gt;The U.S. Food and Drug Administration added a "black box" warning to the class of drugs in 2007, noting that they should not be used in people with gt;heart failuregt;. And in 2008, the U.S. Food and Drug Administration and GlaxoSmithKline notified doctors and pharmacists that patients must now receive a gt;medication guidegt; in each Avandia prescription (a step reserved for drugs that "pose a serious and significant public health concern").gt;gt;"There's a concern about the link between heart disease and the use of thiazolidinediones," says Dace Trence, MD, an endocrinologist and director of the Diabetes Care Center at the University of Washington Medical Center in Seattle.

"There's a concern that [the drugs] will cause heart failure and that's always been a known risk but it's a bit more surprising that there's a link to heart attacks. It's not clear how strong that linkage is."
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