CLINICAL RESEARCH: CLINICAL TRIAL
Improvement of Cardiovascular Risk Markers by Pioglitazone Is Independent From Glycemic Control
Results From the Pioneer Study
Andreas Pfützner, MD, PhD*, ,*,
Nikolaus Marx, MD ,
Georg Lübben, MD ,
Matthias Langenfeld, MD*,
Daniel Walcher, MD,
Thomas Konrad, MD|| and
Thomas Forst, MD*
* IKFE—Institute for Clinical Research and Development, Mainz, Germany
University of Applied Sciences, Rheinbach, Germany
University Hospital, Ulm, Germany
Takeda Pharma GmbH, Aachen, Germany
|| ISF—Institute for Metabolic Research, Frankfurt, Germany
Manuscript received October 12, 2004;
revised manuscript received February 14, 2005,
accepted March 10, 2005.
* Reprint requests and correspondence: Dr. Andreas Pfützner, Institute for Clinical Research and Development, Parcusstr. 8, D-55116 Mainz, Germany. (Email: AndreasP{at}ikfe.de).
OBJECTIVES: This study was performed to assess whether the anti-inflammatory and antiatherogenic effects of pioglitazone suggested by animal experiments are reproducible in man and independent from improvements in metabolic control.
BACKGROUND: Type 2 diabetes is associated with increased cardiovascular risk.
METHODS: A total of 192 patients were enrolled into a six-month, prospective, open-label, controlled clinical study. They were randomized to receive either pioglitazone (45 mg) or glimepiride (1 to 6 mg, with the intent to optimize therapy). Biochemical and clinical markers to assess therapeutic effects included HbA1c, fasting glucose, insulin, adiponectin, lipids, high-sensitivity C-reactive protein (hsCRP), intracellular adhesion molecule, vascular cell adhesion molecule, vascular endothelial growth factor, fibrinogen, von Willebrand factor, matrix metalloproteinase (MMP)-9, monocyte chemoattractant protein (MCP)-1, soluble CD40 ligand, and carotid intima-media thickness (IMT).
RESULTS: The study was completed by 173 patients (66 female, 107 male; age [± SD]: 63 ± 8 years; disease duration: 7.2 ± 7.2 years; HbA1c: 7.5 ± 0.9%; pioglitazone arm: 89 patients). A comparable reduction in HbA1c was seen in both groups (p < 0.001). In the pioglitazone group, reductions were observed for glucose (p < 0.001 vs. glimepiride group at end point), insulin (p < 0.001), low-density lipoprotein/high-density lipoprotein ratio (p < 0.001), hsCRP (p < 0.05), MMP-9 (p < 0.05), MCP-1 (p < 0.05), and carotid IMT (p < 0.001), and an increase was seen in high-density lipoprotein (p < 0.001) and adiponectin (p < 0.001). Spearman ranks analysis revealed only one correlation between the reduction in cardiovascular risk parameters and the improvement in the metabolic parameters (MMP-9 and fasting blood glucose, p < 0.05)
CONCLUSIONS: This prospective study gives evidence of an anti-inflammatory and antiatherogenic effect of pioglitazone versus glimepiride. This effect is independent from blood glucose control and may be attributed to peroxisome proliferator-activated receptor gamma activation.
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Abbreviations and Acronyms
| | HDL = high-density lipoprotein | | hsCRP = high-sensitivity C-reactive protein | | ICAM = intracellular adhesion molecule | | IMT = intima-media thickness | | LDL = low-density lipoprotein | | MCP = monocyte chemoattractant protein | | MMP = matrix metalloproteinase | PPAR = peroxisome proliferator-activated receptor gamma | | PROactive = Prospective Pioglitazone Clinical Trial in Macrovascular Events | | sCD40L = soluble CD40 ligand | | TZD = thiazolidinedione | | VCAM = vascular cell adhesion molecule | | VEGF = vascular endothelial growth factor |
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