Effects of pioglitazone on fasting and postprandial levels of lipid and hemostatic variables in overweight non-diabetic patients with coronary artery disease.
OBJECTIVE
To evaluate the effects of pioglitazone on insulin sensitivity and levels of biomarkers associated with thrombotic risk in overweight and obese, non-diabetic subjects with coronary artery disease.


BACKGROUND
Little information is available regarding the effects of thiazolidinediones in the absence of diabetes. Further, although postprandial hyperlipemia is a risk factor for cardiovascular diseases, there is limited information about the postprandial effects.


METHODS
Twenty overweight and obese, non-diabetic patients with coronary artery disease were enrolled in a randomized, placebo-controlled, double-blind study. Subjects were on atorvastatin for the duration of the study and received either placebo or pioglitazone (45 mg day(-1)) for 12 weeks and then crossed over to the alternative therapy for an additional 12 weeks. Insulin sensitivity, fasting and postprandial levels of lipid, hemostatic, and inflammatory variables were measured, and endothelial function was assessed.


RESULTS
Insulin sensitivity improved from 0.03 micromol kg(-1) x min pM(-1) on placebo to 0.04 on pioglitazone (P = 0.0002), and there were decreases in fasting levels of factor (F) VII:C (102 +/- 17% to 92 +/- 18%, P = 0.001), FVII:Ag (68 +/- 12% to 60 +/- 14%, P = 0.01) and in von Willebrand factor (VWF) (174 +/- 94% to 142 +/- 69%, P = 0.01). Pioglitazone lowered postprandial levels of FVII:Ag, FVII:C, plasminogen activator inhibitor-1, VWF, and triglycerides, and increased high-density lipoproteins (+9%, P = 0.02).


CONCLUSIONS
Pioglitazone improves insulin sensitivity and favorably modifies fasting and postprandial lipid, hemostatic and inflammatory markers of the metabolic syndrome in overweight and obese non-diabetic patients with coronary artery disease.
Mieszczanska
H
H
Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
Kaba
N K
NK
Francis
C W
CW
Gerich
J E
JE
Dodis
R
R
Schwarz
K Q
KQ
Phipps
R P
RP
Smith
B H
BH
Lee
M
M
Messing
S
S
Taubman
M B
MB
D000328:Adult; D000368:Aged; D003324:Coronary Artery Disease / Q000150:complications / Q000188:drug therapy*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005215:Fasting; D005260:Female; D006487:Hemostasis / Q000187:drug effects*; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000188:drug therapy*; D007328:Insulin / Q000097:blood; D008297:Male; D008875:Middle Aged; D050177:Overweight; D000077205:Pioglitazone; D019518:Postprandial Period; D045162:Thiazolidinediones / Q000494:pharmacology / Q000627:therapeutic use*
D007328:Insulin; D045162:Thiazolidinediones; D000077205:Pioglitazone