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Steven Nissen, chairman of the Department of Cardiovascular Medicine at the Cleveland Clinic, published a study that found Avandia showed a 43 percent greater risk of heart attack among diabetes patients, and he remains convinced that the drug should not be used. Three other studies (mean duration 41 months; 14,067 total patients), comparing Avandia to some other approved oral antidiabetic agents or placebo, have not confirmed or excluded this risk. The FDA has requested that Avandia's maker, GlaxoSmithKline, strengthen its warning about heart-failure risk. Therefore, Avandia should not be used in patients with type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis. Steven Nissen, co-author of the 2007 paper and chairman of the department of cardiovascular medicine at the Cleveland Clinic, stated that the RECORD trial was "seriously flawed," citing the fact that more patients in the Avandia group were taking cholesterol-lowering statins and that group had what looked to be a high drop-out rate.

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