Decreasing Restenosis Following Angioplasty

The potential of peroxisome proliferator-activated receptor γ agonists

Patients with type 2 diabetes are disproportionately affected by cardiovascular disease (CVD), and cardiovascular events are a major cause for morbidity and mortality in this population. Despite significant improvements in the management of CVD, patients with diabetes continue to be seriously impacted by this problem (1). While treatments with lipid-lowering therapy and aggressive blood pressure lowering have been particularly effective in reducing cardiovascular events, treatments to reduce blood glucose have had a less impressive impact on macrovascular complications (2). In the UKPDS (U.K. Prospective Diabetes Study), only treatment with metformin led to a significant reduction in cardiovascular events in a subgroup of obese subjects (3). Since its original description there has been much experimental, clinical, and epidemiological data to support the association of the insulin resistance syndrome with CVD (4). Additionally, other “nontraditional” cardiovascular risk factors associated with insulin resistance have been frequently implicated in the causation and progression of vascular disease in diabetes (5).

Following cardiovascular interventions such as balloon angioplasty, patients with diabetes appear to have a higher rate of restenosis (6). Although the development of stents has led to an improvement in outcomes, people with diabetes continue to have a worse prognosis than those without this disorder (7–10). Our understanding of the pathophysiology of restenosis has improved significantly, and increased attention has been focused on the role of insulin resistance in the development of …