Pioglitazone delayed atheroma progression in patients with diabetes

Nicholls SJ. J Am Coll Cardiol. 2011;57:153-159.

Patients with type 2 diabetes who were treated with pioglitazone experienced improvements in triglyceride–to–HDL ratio that were associated with delayed progression of atheroma, according to newly published data.

In a study of 360 patients with type 2 diabetes and coronary artery disease, patients were treated with either 15 mg to 45 mg of pioglitazone (Actos, Takeda) with dose titration or 1 mg to 4 mg of glimepiride for 18 months. Researchers used serial IVUS to determine the relationship between changes in percent atheroma volume, total atheroma and biochemical parameters.

According to results, patients treated with pioglitazone had greater increases in HDL as well as reductions in triglycerides, C-reactive protein and hemoglobin when compared with glimepiride. For patients taking pioglitazone, changes in percent atheroma correlated with triglycerides (P=.04), glycated hemoglobin (P=.03) and triglyceride/HDL-C ratio (P=.03), whereas for glimepiride use, changes in percent atheroma were associated with changes in LDL (P=.05), apolipoprotein B (P=.04) and apolipoprotein A-I (P=.01).

On multivariable analysis, pioglitazone’s effect on triglyceride/HDL was associated with changes in percent atheroma (P=.03) and total atheroma (P=.02) volume.

The study’s findings, the researchers wrote, “[support] the hypothesis that pioglitazone halted disease progression predominantly because of its properties beyond glycemic control. These findings are also consistent with clinical outcome data indicating the importance of atherogenic dyslipidemia as a target for therapeutic manipulation in patients with diabetes to achieve more effective prevention of cardiovascular disease.” – by Brian Ellis

Nicholls et al provides us with some important new information about the effects of pioglitatzone, a drug that is likely to be increasingly prescribed in patients with diabetes. That pioglitazone has the potential to confer CV benefits through secondary mechanisms on triglyceride, HDL and atheroma burden is a win-win for high risk patients who take the drug as part of their diabetes regimen. It may delay or prevent the need for additional triglyceride-lowering or HDL-raising therapies in some patients, which can minimize cost and pill burden..

– Rhonda Cooper-DeHoff, PharmD
Associate Professor, Department of Pharmacotherapy and Translational Research,
Colleges of Pharmacy and Medicine, University of Florida

Disclosure: Dr. Cooper-DeHoff reports no relevant financial disclosures.

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