In the trial by Berhanu 2006, insulin only patients had a higher incidence of cardiac events (10.7% versus 5.5%) but the majority were ECG abnormalities rather than patient oriented outcomes; there was one patient each with myocardial infarction and cardiac hypertrophy in the insulin only group, and one patient with coronary artery disease in the pioglitazone group; no deaths were observed. Here, INS is linked to cardiac hypertrophy.