Improving cardiovascular risk--applying evidence-based medicine to glucose-lowering therapy with thiazolidinediones in patients with type 2 diabetes.
BACKGROUND
The management of patients with type 2 diabetes aims to reduce the elevated risk of cardiovascular disease (CVD) by addressing established risk factors including hyperglycaemia, dyslipidaemia and hypertension. The thiazolidinediones are equally effective in improving glycaemic control when used in combination regimens in patients with type 2 diabetes, but have differing effects on the diabetic dyslipidaemia.


OBJECTIVE
To compare the effects of rosiglitazone and pioglitazone on inflammatory mediators associated with atherosclerosis and CVD, surrogate cardiovascular endpoints, and hard cardiovascular outcomes in patients with type 2 diabetes.


METHODS
A search of the PubMed database plus manual search of referenced papers for other relevant citations.


RESULTS
Both glitazones reduce inflammatory markers and other circulating markers of CV disease. Available data suggest that pioglitazone can delay progression of atherosclerosis in patients with type 2 diabetes, as shown by the PERISCOPE and CHICAGO studies, and that it can reduce the rate of clinical CV events as shown by PROactive. Clinical end-point data for rosiglitazone are inconclusive, providing no evidence of benefit and a possible increase in myocardial infarction.


CONCLUSIONS
There is a consistency of benefit with pioglitazone on markers, surrogate cardiovascular outcomes and clinical end-point trials.


CONCLUSIONS
Pioglitazone is the preferred thiazolidinedione to reduce cardiovascular risk in people with type 2 diabetes.
Fisher
M
M
Glasgow Royal Infirmary, Glasgow, UK. miles.fisher@ggc.scot.nhs.uk
D050197:Atherosclerosis / Q000097:blood / Q000473:pathology / Q000517:prevention & control*; D015415:Biomarkers / Q000378:metabolism; D001786:Blood Glucose / Q000378:metabolism; D002340:Carotid Artery Diseases / Q000473:pathology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000473:pathology / Q000517:prevention & control*; D003925:Diabetic Angiopathies / Q000097:blood / Q000473:pathology / Q000517:prevention & control*; D004730:Endothelium, Vascular; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008055:Lipids / Q000097:blood; D000077205:Pioglitazone; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012307:Risk Factors; D000077154:Rosiglitazone; D015607:Stents; D045162:Thiazolidinediones / Q000627:therapeutic use*; D017539:Tunica Intima; D017540:Tunica Media; D014655:Vascular Resistance
D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D008055:Lipids; D000077205:Pioglitazone; D000077154:Rosiglitazone; D045162:Thiazolidinediones