Effect of Pioglitazone Compared With Glimepiride on Carotid Intima-Media Thickness in Type 2 Diabetes

Abstract

ATIENTS WITH TYPE 2 DIABETES mellitus (DM) have a marked increase in the risk of myocardial infarction (MI), and a substantially worse prognosis after MI compared with patients without diabetes. [1][2][3] In recent years, it has become apparent that optimal control of blood pressure and low-density lipoprotein cholesterol (LDL-C) level can substantially reduce excess cardiovascular risk in patients with diabetes. 4-6 However, even with optimal control of these potent cardiovascular risk factors, incremental risk for cardiovascular events remains high compared with individuals without diabetes. 2,3,6 New approaches are, therefore, needed to further reduce cardiovascular risk in patients with diabetes.Emerging evidence suggests that thiazolidinediones could be useful for reducing cardiovascular risk. In isolated vessel-wall cells, troglitazone, pioglitazone, and rosiglitazone have been shown to modulate gene expression in a manner that would be predicted to be atheroprotective in vivo. 7,8 In hu-mans, these agents have been shown to have beneficial effects on systemic inflammatory and coagulation markers, lipoprotein profile, and endothelial cell function. 9-12 Some of these beneficial ef-Author Affiliations are listed at the end of this article.

Métodos por imagem da aterosclerose em estudos de progressão/regressão: marcador substituto ou janela direta para o processo patológico da aterosclerose?

“…An associated imaging study evaluated the effect of pioglitazone vs. glimepiride on changes in CIMT 113 . In that study, 462 adults with type-2 DM (mean duration, 7.7 years; mean HbA1c value, 7.4%) were randomized to pioglitazone hydrochloride (15-45 mg/day) or glimepiride (1-4 mg/day).…”

Type 2 Diabetes and Cardiovascular Disease: Reducing the Risk

“…68 Patients (n=462) were newly diagnosed and currently treated with diet and exercise, sulfonylurea, metformin, insulin, or any combination of these. In addition to current therapy, patients received either pioglitazone or glimepiride.…”

“…At the end of the study period (week 72), progression of mean CIMT was less with pioglitazone compared with glimepiride (-0.001 mm vs. +0.012 mm; 95% CI, -0.024 to -0.002; P = 0.02). 68 Other benefits of pioglitazone included increased HDL-C levels and reduced TG levels. ADEs leading to study discontinuation occurred 11.3% for pioglitazone-treated patients versus 8.3% for glimepiride-treated patients.…”

The Current Role of Glucose Control Medications in Primary and Secondary Prevention for Cardiovascular Disease

“…However, the IRIS results are consistent with the findings regarding a secondary outcome in the PROactive trial (i.e., that the rates of death, myocardial infarction, or stroke were significantly lower with pioglitazone than with placebo) and with the findings of trials showing a favorable effect of pioglitazone on the progression of subclinical atherosclerosis among patients with or without diabetes. 20,[24][25][26] Finally, we must remember that The Diabetes Control and Complications Trial (DCCT) established the importance of tight glucose control to lessen the risks of both micro vascular and macro vascular disease in type 1 DM patients. A 27 year follow-up of this trial showed that 6.5 years of initial intensive DM therapy in type 1 DM was associated with a modestly lower all-cause mortality rate when compared with conventional therapy.…”