A Comparison of Lipid and Glycemic Effects of Pioglitazone and Rosiglitazone in Patients With Type 2 Diabetes and Dyslipidemia: Response to Goldberg et al.

doi:10.2337/diacare.28.12.2983-a

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Letters: Comments and Responses
Letter: Comments and Responses

A Comparison of Lipid and Glycemic Effects of Pioglitazone and Rosiglitazone in Patients With Type 2 Diabetes and Dyslipidemia

Response to Goldberg et al.

David S.H. Bell, MB, FACE

From the Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama

Address correspondence to David S. H. Bell, MB, FACE, Faculty Office Tower, Room 754, 510 South 20th St., Birmingham, AL 35294. E-mail: dshbell{at}uab.edu

The study by Goldberg et al. (1) in the July issue of DiabetesCare concluded that, compared with rosiglitazone, pioglitazonewas associated with improvements in triglycerides, HDL cholesterol,LDL concentration, and LDL particle size.

It should first be noted that 4,410 subjects were screened toobtain 735 eligible subjects. This was a highly selective group,and therefore this was an enriched study. Second, recognizedgoals for the diabetic patient were not reached with eitherpioglitazone or rosiglitazone for triglycerides, non-HDL cholesterol,and LDL cholesterol. Third, HDL particle size, which shouldhave been available from the proton nuclear magnetic resonancespectroscopy of Liposcience, was not reported. Why was thisomitted from both the American Heart Association presentationand the Diabetes Care study?

Finally, and most importantly, based on the Collaborative AtorvastatinDiabetes and Heart Protection Studies (2,3), it is now wellrecognized that irrespective of LDL levels, all type 2 diabeticpatients benefit from statin therapy. Without concomitant statintherapy, these results have little clinical significance. Thisis especially important since two studies have clearly shownthat when simvastatin or ezetimibe are coadministered with thiazolidinedionesthere are no significant differences in the lipid profile ofthose subjects on pioglitazone or rosiglitazone (4,5).

It is now clear for many studies that rosiglitazone does notdecrease fasting triglycerides. However, two recent studieshave shown that rosiglitazone does significantly decrease postprandialtriglyceride levels. One study has shown that this is not thecase with pioglitazone (8). While uncertainty surrounds therole of fasting triglycerides as a cardiac risk factor, thereis little doubt that elevated postprandial triglycerides area risk factor (9).

References

Goldberg RB, Kendall DM, Deeg MA, Buse JB, Zagar AJ, Pinaire JA, Tan MH, Khan MA, Perez AT, Jacober SJ, the GLAI Study Investigators: A comparison of lipid and glycemic effects of pioglitazone in patients with type 2 diabetes and dyslipidemia. Diabetes Care28 :1547 –1554,2005[Abstract/Free Full Text]
Colhoun HM, Betteridge DJ, Durrington PN, Hitman GA, Neil HA, Livingstone SJ, Thomason MJ, Mackness MI, Charlton-Menys V, Fuller JH, the CARDS Investigators: Primary prevention of cardio vascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS) multicenter randomized placebo controlled trial. Lancet364 :685 –696,2004[Medline]
Collins R, Armitage J, Parish S, Sleigh P, Peto R, the Heart Protection Study Collaborative Group: MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 5963 people with diabetes: a randomized placebo-controlled trial. Lancet361 :2005 –2016,2003[Medline]
Lewin AJ, Kipnes MS, Meneghini LF, Plotkin DJ, Perevozskaya IT, Shah S, Maccubbin DL, Mitchel YB, Tobert JA, the Simvastatin/Thiazolidinedione Study Group: Effects of simvastatin on the lipid profile and attainment of low-density lipoprotein cholesterol goals when added to a thiazolidinedione therapy in patients with type 2 diabetes mellitus: a multicenter, randomized double blind placebo controlled trial. Clin Ther36 :379 –389,2004
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Tan GD, Fielding BA, Currie JM, Humphreys SM, Desage M, Frayn KN, Laville M, Vidal H, Karpe F: The effects of rosiglitazone on fatty acid and triglyceride metabolism in type 2 diabetes. Diabetologia48 :83 –95,2005[Medline]
Van Wijk JPH, de Koning EJP, Castro Cabezas M, Rabelink TJ: Rosiglitazone improves postprandial triglyceride and free fatty acid metabolism in type 2 diabetes. Diabetes Care28 :844 –849,2005[Abstract/Free Full Text]
Shimono D, Kuwamura N, Nakamura Y, Koshiyama H: Lack of effect of pioglitazone on postprandial triglyceride levels in type 2 diabetes. Diabetes Care24 :971 ,2001[Free Full Text]
Stampfer MJ, Krauss RM, Ma J, Blanche PJ, Holl LG, Sacks FM, Hennekens CH: A prospective study of triglyceride level, low-density lipoprotein particle diameter and risk of myocardial infarction. JAMA276 :882 –888,1996[Abstract]