Comparison Of Effects Of Thiazolidinediones On Cardiovascular Risk Factors: Observations From A Clinical Practice

Effects of pioglitazone on lipid and lipoprotein profiles in patients with type 2 diabetes and dyslipidaemia after treatment conversion from rosiglitazone while continuing stable statin therapy

“…The primary outcome measure, fasting triglycerides, was significantly reduced by 15% after 17 weeks of pioglitazone treatment after treatment conversion from rosiglitazone. This reduction is comparable with that seen in a small retrospective analysis in patients previously treated with troglitazone and statins 14 and is in line with differences seen in a randomised, controlled head-to-head study of pioglitazone and rosiglitazone without statins. 18 Total cholesterol levels showed significant reductions after pioglitazone treatment, consistent with previous uncontrolled and controlled head-to-head studies.…”

“…12 Pioglitazone also has been shown to reduce the number of LDL particles and to shift small, dense LDL particles to larger, less atherogenic particles, 13 which may provide additional benefits in the high-risk patient with type 2 diabetes and dyslipidaemia. Further effects on the diabetic dyslipidaemia profile have been observed in retrospective comparative studies [14][15][16] and in a prospective, randomised conversion study from troglitazone to pioglitazone or rosiglitazone. 17 Recently, a large, head-to-head, randomised controlled study comparing pioglitazone and rosiglitazone in patients naïve to treatment with statins or antidiabetic agents confirmed the differences in lipid response observed in earlier uncontrolled studies.…”

“…17 Recently, a large, head-to-head, randomised controlled study comparing pioglitazone and rosiglitazone in patients naïve to treatment with statins or antidiabetic agents confirmed the differences in lipid response observed in earlier uncontrolled studies. [14][15][16][17] The present study, designated as COMPLEMENT (to reflect its complementarity to the headto-head study done without statins 18 ), was designed to take into account the fact that most patients with type 2 diabetes meet the criteria for treatment with statins. 6 It was designed to determine whether lipid improvements conferred by pioglitazone in the head-to-head statin-naïve study 18 would be observed in patients who were switched from rosiglitazone to pioglitazone while maintaining constant statin and other lipid-altering therapies.…”

Oral Antihyperglycemic Therapy for Type 2 Diabetes

“…The 2 TZDs currently available, rosiglitazone and pioglitazone, appear to have similar efficacy on glycemia. 120 Adverse effects of TZDs include weight gain, which can be as great or greater than that with the SUs. Weight gain appears to involve mostly peripheral subcutaneous sites, with a reduction in visceral fat depots, 121 the latter being better correlated with insulin resistance.…”

Επίδραση Της Φαρμακευτικής Αγωγής Στη Λειτουργία Των Β - Κυττάρων Και Στην Αντίσταση Στην Ινσουλίνη Σε Ασθενείς Με Σακχαρώδη Διαβήτη Τύπου 2

“…Αναφέρεται από διάφορες µελέτες ότι οι TZDs µπορεί να έχουν ευνοϊκή επίδραση πάνω σε παράγοντες καρδιαγγειακού κινδύνου όπως κυτοκίνες και δείκτες φλεγµονής, λιπίδια, αρτηριακή πίεση, ενδοθηλιακή δυσλειτουργία και κυτταρικές και µοριακές διαδικασίες που ρυθµίζουν την εξέλιξη της αθηροσκλήρωσης. 317,[339][340][341][342][343][344] Πάντως όπως φάνηκε από τη µελέτη PROactive, που ήταν µελέτη δευτερογενούς πρόληψης και αφορούσε σακχαροδιαβητικούς ασθενείς τύπου 2 µε εγκατεστηµένη µακροαγγειακή νόσο, δεν υπήρξε στατιστικά σηµαντική διαφορά (p = 0,095 ) στο σύνολο των πρωτευόντων καταληκτικών σηµείων (θάνατοι, εµφράγµατα µυοκαρδίου, οξέα στεφανιαία σύνδροµα, στεφανιαία επαναιµάτωση, αγγειακά εγκεφαλικά επεισόδια, ακρωτηριασµός κάτω άκρων, επαναιµάτωση κάτω άκρων) ανάµεσα στην οµάδα που έλαβε πιογλιταζόνη (15-45 mg) και στην οµάδα ελέγχου. Βέβαια θα πρέπει να σηµειωθεί ότι υπήρξε στατιστικά σηµαντική διαφορά στο σύνολο των κύριων δευτερευόντων καταληκτικών σηµείων (θάνατοι, εµφράγµατα µυοκαρδίου-πλην σιωπηλών εµφραγµάτων και αγγειακά εγκεφαλικά επεισόδια) που ήταν λιγότερα στην οµάδα της πιογλιταζόνης (p = 0,027).…”