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Pioglitazone Attenuates Atherosclerotic Plaque Inflammation in Patients With Impaired Glucose Tolerance or Diabetes: A Prospective, Randomized, Comparator-Controlled Study Using Serial FDG PET/CT Imaging Study of Carotid Artery and Ascending Aorta
JACC Cardiovascular Imaging, 10/14/2011
Clinical Article
Mizoguchi M et al. – This present study suggests that pioglitazone could attenuate atherosclerotic plaque inflammation in patients with impaired glucose tolerance or in diabetic patients independent of glucose lowering effect. Pioglitazone may be a promising strategy for the treatment of atherosclerotic plaque inflammation in impaired glucose tolerance or diabetic patients.
Methods- A total of 56 impaired glucose tolerant or diabetic patients with carotid atherosclerosis underwent a complete history, determinations of blood chemistries, anthropometric variables, and FDG–PET.
- They were randomly assigned to receive either pioglitazone (15 to 30 mg) or glimepiride (0.5 to 4.0 mg) for 4 months with titration to optimal dosage.
- Effects of the drugs on atherosclerotic plaque inflammation were evaluated by FDG–PET at study completion.
- Plaque inflammation was measured by blood–normalized standardized uptake value, known as a target–to–background ratio.
- The study was completed in 31 pioglitazone–treated patients and 21 glimepiride–treated patients.
- Although both treatments reduced fasting plasma glucose and hemoglobin A1c values comparably, pioglitazone, but not glimepiride, decreased atherosclerotic plaque inflammation.
- Compared with glimepiride, pioglitazone significantly increased high–density lipoprotein cholesterol level.
- High–sensitivity C–reactive protein was decreased by pioglitazone, whereas it was increased by glimepiride.
- Multiple stepwise regression analysis revealed that the increase in high–density lipoprotein cholesterol level was independently associated with the attenuation of plaque inflammation.
