Improved cardiac function after sirolimus-eluting stent placement in diabetic patients by pioglitazone: combination therapy with statin.
BACKGROUND
Peroxisome proliferator-activated receptor-gamma (PPAR-gamma) agonists are used as anti-diabetic drugs, and their pleiotrophic action has been reported to improve endothelial function leading to cardioprotective effects. In this study we evaluated the long-term effect of pioglitazone on cardiac function in diabetic patients after percutaneous coronary intervention (PCI) by drug-eluting stent (DES).


RESULTS
We investigated 54 diabetic patients who received PCI using a sirolimus-eluting stent. We excluded cases of acute myocardial infarction. They were divided into two groups: Group C received only conventional therapy (n=26) and Group P received additionally pioglitazone 15 mg/day (n=28). The left ventricular ejection fraction (LVEF) was measured by left ventriculography and analyzed before and 8 months after PCI. In Group C, LVEF did not change significantly: 55.6% vs. 56.7%, before and after PCI respectively (p=0.58). However, pioglitazone significantly improved LVEF: 54.4% vs. 60.0% (p=0.014). Multiple linear regression analysis showed that DeltaLVEF was significantly related to pioglitazone therapy (p=0.037). In particular, the combination of pioglitazone and statin improved LVEF (DeltaLVEF 9.6% with vs. 2.2% without statin).


CONCLUSIONS
Pioglitazone improved cardiac function after PCI using SES in diabetic patients, especially in combination with a statin.
Ozawa
Takuya
T
Department of Cardiology, Niigata City General Hospital, Niigata, Japan. takuya-o@med.niigata-u.ac.jp
Oda
Hirotaka
H
Oda
Masato
M
Hosaka
Yukio
Y
Kashimura
Takeshi
T
Ozaki
Kazuyuki
K
Tsuchida
Keiichi
K
Takahashi
Kazuyoshi
K
Miida
Tsutomu
T
Aizawa
Yoshifusa
Y
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003131:Combined Modality Therapy; D003920:Diabetes Mellitus / Q000503:physiopathology* / Q000628:therapy*; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D047495:PPAR gamma / Q000819:agonists*; D000077205:Pioglitazone; D020123:Sirolimus / Q000627:therapeutic use*; D013318:Stroke Volume; D045162:Thiazolidinediones / Q000627:therapeutic use*; D016896:Treatment Outcome; D016277:Ventricular Function, Left
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007004:Hypoglycemic Agents; D047495:PPAR gamma; D045162:Thiazolidinediones; D020123:Sirolimus; D000077205:Pioglitazone