Reduction of neointimal hyperplasia after coronary stenting by pioglitazone in nondiabetic patients with metabolic syndrome.
BACKGROUND
This study investigates whether pioglitazone reduces neointimal hyperplasia after coronary stenting in nondiabetic patients with metabolic syndrome (MS) using intravascular ultrasound (IVUS). Pioglitazone, a novel insulin-sensitizing thiazolidinedione, has been shown to reduce neointimal hyperplasia after coronary stenting in patients with type 2 diabetes. However, the effect of pioglitazone on in-stent restenosis in nondiabetic patients with MS remains unknown.


RESULTS
Twenty-eight nondiabetic patients with MS after bare-metal stent implantation were randomized to 6-month treatment with or without 30 mg/d of pioglitazone (pioglitazone group [PIO] of 14 patients with 16 lesions and control group [CONT] of 14 patients with 16 lesions). At baseline and at 6-month follow-up, assessment of insulin resistance and visceral fat accumulation, quantitative coronary angiographic analysis, and IVUS measurements were performed. Pioglitazone treatment improved insulin resistance and decreased visceral fat accumulation without significant changes in plasma glucose levels, glycosylated hemoglobin A1c levels, and lipid profiles. Intimal index (intimal area/stent area) and intimal area were reduced in PIO compared with CONT (13% +/- 7% vs 21% +/- 13%, P = .033; 1.28 +/- 0.76 mm2 vs 1.90 +/- 1.16 mm2, P = .084; respectively). Binary restenosis rate was 0% in PIO versus 31% in CONT (P = .043).


CONCLUSIONS
This is the first randomized, prospective IVUS study demonstrating that pioglitazone reduces neointimal hyperplasia after coronary stenting in nondiabetic patients with MS. Our data suggest that pioglitazone treatment may represent a novel therapeutic tool to target in-stent restenosis in nondiabetic patients with MS.
Katayama
Takuji
T
Department of Internal Medicine, Omiya Medical Center, Jichi Medical University, Saitama City, Japan.
Ueba
Hiroto
H
Tsuboi
Ken
K
Kubo
Norifumi
N
Yasu
Takanori
T
Kuroki
Masatoshi
M
Saito
Muneyasu
M
Momomura
Shin-ichi
S
Kawakami
Masanobu
M
D023903:Coronary Restenosis / Q000209:etiology / Q000517:prevention & control; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006965:Hyperplasia / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000628:therapy*; D008875:Middle Aged; D000077205:Pioglitazone; D015607:Stents; D045162:Thiazolidinediones / Q000627:therapeutic use*; D016896:Treatment Outcome; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000473:pathology*; D018084:Ultrasonography, Interventional
D007004:Hypoglycemic Agents; D045162:Thiazolidinediones; D000077205:Pioglitazone