HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sourij, H. Articles by Wascher, T. C. Search for Related Content PubMed PubMed Citation Articles by Sourij, H. Articles by Wascher, T. C. Social Bookmarking                What's this?

Effects of Pioglitazone on Endothelial Function, Insulin Sensitivity, and Glucose Control in Subjects With Coronary Artery Disease and New-Onset Type 2 Diabetes

¹ Department of Internal Medicine, Metabolism and Vascular Biology Unit, Medical University of Graz, Austria
² Division of Cardiology, Medical University of Graz, Austria

Address correspondence reprint requests to Harald Sourij, MD, Department of Internal Medicine, MetabolismVascular Biology Unit, Medical University of Graz, Auenbruggerpl. 15, A-8036 Graz, Austria. E-mail: ha.sourij{at}meduni-graz.at

OBJECTIVE—About one of five patients with coronary artery disease (CAD) suffers from previously unknown, predominantly postprandial type 2 diabetes. In the process of atherogenesis and the subsequent increased cardiovascular mortality of diabetic patients, endothelial dysfunction is suspected to play an important role, and it is observed in diabetic as well as insulin-resistant states. Thus, the aim of our study was to investigate the effect of pioglitazone on endothelial dysfunction, insulin sensitivity, and glucose control in newly detected type 2 diabetic patients with CAD.

RESEARCH DESIGN AND METHODS—We investigated 42 patients (39 men and 3 women, age 60.25 ± 7.5 years, HbA_1c 6.1 ± 0.5%) with manifest CAD and newly detected type 2 diabetes. A randomized, double-blind, placebo-controlled, parallel study with pioglitazone (30 mg/day for 12 weeks) was performed. At study entry and end, we performed an oral glucose tolerance test and measurements of endothelial dysfunction by photoplethysmographic pulse wave analysis.

RESULTS—Endothelial dysfunction was severely impaired at baseline in both groups. After 12 weeks, endothelial dysfunction was significantly better in the pioglitazone group (change of reflection index 6.5 ± 5.1 vs. 1.6 ± 2.9%, P = 0.002) compared with placebo. Insulin sensitivity, as assessed by homeostasis model assessment (2.20 ± 1.62 vs. 3.61 ± 1.87, P = 0.01), or the change of insulin sensitivity index from baseline to study end (0.021 ± 0.023 vs. –0.003 ± 0.012 µmol · kg^–1 · min^–1 per pmol/l, P = 0.0001) and ß-cell function (57.42 ± 49.86 vs. 21.78 ± 18.54 mU/l per mmol/l, P = 0.0014) significantly improved in the pioglitazone group, with no change observed after placebo.

CONCLUSIONS—Pioglitazone improves endothelial dysfunction independently from the observed benefits on insulin sensitivity and ß-cell function in patients with newly diagnosed type 2 diabetes and CAD.

Abbreviations: CAD, coronary artery disease • HOMA, homeostasis model assessment • MAPK, mitogen-activated protein kinase • NF-B, nuclear factor-B • OGTT, oral glucose tolerance test • PI, phosphoinositol • RI, reflection index • TZD, thiazolidinedione

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				R. Muniyappa, M. Montagnani, K. K. Koh, and M. J. Quon Cardiovascular Actions of Insulin Endocr. Rev., August 1, 2007; 28(5): 463 - 491. [Abstract] [Full Text] [PDF]