Peroxisome proliferator-activated receptor gamma agonists for the Prevention of Adverse events following percutaneous coronary Revascularization--results of the PPAR study.
BACKGROUND
Patients with metabolic syndrome are at increased risk for cardiovascular complications. We sought to determine whether peroxisome proliferator-activated receptor gamma agonists had any beneficial effect on patients with metabolic syndrome undergoing percutaneous coronary intervention (PCI).


METHODS
A total of 200 patients with metabolic syndrome undergoing PCI were randomized to rosiglitazone or placebo and followed for 1 year. Carotid intima-medial thickness (CIMT), inflammatory markers, lipid levels, brain natriuretic peptide, and clinical events were measured at baseline, 6 months, and 12 months.


RESULTS
There was no significant difference in CIMT between the 2 groups. There was no difference in the 12-month composite end point of death, myocardial infarction (MI), stroke, or any recurrent ischemia (31.4% vs 30.2%, P = .99). The rate of death, MI, or stroke at 12 months was numerically lower in the rosiglitazone group (11.9% vs 6.4%, P = .19). There was a trend toward a greater decrease over time in high-sensitivity C-reactive protein values compared with baseline in the group randomized to rosiglitazone versus placebo both at 6 months (-35.4% vs -15.8%, P = .059) and 12 months (-40.0% vs -20.9%, P = .089) and higher change in high-density lipoprotein (+15.5% vs +4.1%, P = .05) and lower triglycerides (-13.9% vs +14.9%, P = .004) in the rosiglitazone arm. There was a trend toward less new onset diabetes in the rosiglitazone group (0% vs 3.3%, P = .081) and no episodes of symptomatic hypoglycemia. There was no excess of new onset of clinical heart failure in the rosiglitazone group, nor was there a significant change in brain natriuretic peptide levels.


CONCLUSIONS
Patients with metabolic syndrome presenting for PCI are at increased risk for subsequent cardiovascular events. Rosiglitazone for 12 months did not appear to affect CIMT in this population, although it did have beneficial effects on high-sensitivity C-reactive protein, high-density lipoprotein, and triglycerides. Further study of peroxisome proliferator-activated receptor agonism in patients with metabolic syndrome undergoing PCI may be warranted.
Bhatt
Deepak L
DL
Cleveland Clinic, Department of Cardiovascular Medicine, 9500 Euclid Avenue, Cleveland, OH 44195, USA. bhattd@ccf.org
Chew
Derek P
DP
Grines
Cindy
C
Mukherjee
Debabrata
D
Leesar
Massoud
M
Gilchrist
Ian C
IC
Corbelli
John C
JC
Blankenship
James C
JC
Eres
Avichai
A
Steinhubl
Steven
S
Tan
Walter A
WA
Resar
Jon R
JR
AlMahameed
Amjad
A
Abdel-Latif
Ahmed
A
Tang
W H Wilson
WH
Tang
H Wilson
HW
Brennan
Danielle
D
McErlean
Ellen
E
Hazen
Stanley L
SL
Topol
Eric J
EJ
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D015415:Biomarkers / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D003327:Coronary Disease / Q000209:etiology / Q000378:metabolism / Q000628:therapy*; D018450:Disease Progression; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000378:metabolism; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D047495:PPAR gamma / Q000819:agonists*; D010865:Pilot Projects; D000077154:Rosiglitazone; D045162:Thiazolidinediones / Q000627:therapeutic use*
D015415:Biomarkers; D007004:Hypoglycemic Agents; D047495:PPAR gamma; D045162:Thiazolidinediones; D000077154:Rosiglitazone; D020097:Natriuretic Peptide, Brain