Pioglitazone compared with metformin increases pericardial fat volume in patients with type 2 diabetes mellitus.
BACKGROUND
Peroxisome proliferator-activated receptor-gamma agonists are involved in fat cell differentiation.


OBJECTIVE
The objective of the study was to investigate the effect of pioglitazone vs. metformin on pericardial fat volume in type 2 diabetic (T2DM) patients. Furthermore, we aimed to assess the relationship between pericardial fat volume, other fat compartments, and myocardial function at baseline and after treatment.


METHODS
This was a prospective, randomized, double-blind, intervention study.


METHODS
The study was conducted at a university hospital.


METHODS
Patients included 78 men with T2DM (aged 56.5 +/- 0.6 yr; glycosylated hemoglobin 7.1 +/- 0.1%) without structural heart disease.


METHODS
Patients were randomly assigned to pioglitazone (30 mg/d) or metformin (2000 mg/d) and matching placebo during 24 wk.


METHODS
Pericardial and abdominal fat volumes and myocardial left ventricular function were measured by magnetic resonance imaging and hepatic and myocardial triglyceride content by proton magnetic resonance spectroscopy.


RESULTS
Pioglitazone increased pericardial fat volume [30.5 +/- 1.7 ml (baseline) vs. 33.1 +/- 1.8 ml], whereas metformin did not affect pericardial fat volume (29.2 +/- 1.5 ml vs. 29.6 +/- 1.6 ml, between groups P = 0.02). After correction for body mass index and age, only visceral fat volume correlated with pericardial fat volume at baseline (r = 0.55, P < 0.001). The increase in pericardial fat volume induced by pioglitazone was not associated with a decrease in left ventricular diastolic function.


CONCLUSIONS
In T2DM patients, pioglitazone increases pericardial fat volume. This increase in pericardial fat volume did not negatively affect myocardial function after 24 wk. These observations question the notion of an inverse causal relationship between pericardial fat volume and myocardial function.
Jonker
J T
JT
Departments of Endocrinology and Metabolism, Leiden University Medical Center, 2300 RC Leiden, The Netherlands. j.t.jonker@lumc.nl
Lamb
H J
HJ
van der Meer
R W
RW
Rijzewijk
L J
LJ
Menting
L J
LJ
Diamant
M
M
Bax
J J
JJ
de Roos
A
A
Romijn
J A
JA
Smit
J W A
JW
D050153:Abdominal Fat / Q000187:drug effects / Q000473:pathology; D000273:Adipose Tissue / Q000187:drug effects* / Q000473:pathology*; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000473:pathology*; D004311:Double-Blind Method; D006801:Humans; D007004:Hypoglycemic Agents / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D008687:Metformin / Q000494:pharmacology* / Q000627:therapeutic use; D008875:Middle Aged; D009929:Organ Size / Q000187:drug effects; D010496:Pericardium / Q000187:drug effects* / Q000473:pathology; D000077205:Pioglitazone; D010919:Placebos; D045162:Thiazolidinediones / Q000494:pharmacology* / Q000627:therapeutic use
D007004:Hypoglycemic Agents; D010919:Placebos; D045162:Thiazolidinediones; D008687:Metformin; D000077205:Pioglitazone