title: [Anti-atherosclerotic effect of pioglitazone--the first evidence of the role of triglyceride/HDL ratio].
abstract: The presence of multiple risk factors can multiply exponentially the risk of cardiovascular events, thus cardiovascular diseases are more severe in diabetes mellitus. One of the challenges we face today is the application of drugs that, besides improving glucose homeostasis, also have antiatherosclerotic effect. Such candidates are glitazones, which have pleiotropic efficiency beyond their main effect: they improve distribution of adipose tissue, blood pressure and endothelial function and also have anti-inflammatory and anti-coagulation capacity. Regarding the effects on lipid metabolism, there are differences between various glitazones: improvements are mainly achieved by pioglitazone, which markedly reduces triglyceride levels, and also elevates HDL levels and decreases the ratio of small, dense LDL-particles. Studies on clinical outcomes also show the superiority of pioglitazone. Imaging of blood vessels (carotis-IMT, intracoronary ultrasound technique) also suggest a greater efficiency of pioglitazone. According to the latest analysis of the PERISCOPE study, the stability of the coronary plaque was associated only with the triglyceride/ HDL ratio in case of pioglitazone. The newest data also revealed that pioglitazone uniquely increases the cholesterol-efflux attributed to HDL-related macrophages. On the basis of the latest results, pioglitazone not only improves glucose homeostasis, but also has a remarkable anti-atherosclerotic effect, which is primarily due to its favourable lipid metabolism profile.
authors.affiliation: Honvédkórház-Allami Egészségügyi Központ, II. Belgyógyászati Osztály, Budapest/Military Hospital, State Health Centre, 2nd Department of Medicine.
authors.forename: Albert
authors.initials: A
authors.lastname: Császár
mesh_terms: D000818:Animals; D000893:Anti-Inflammatory Agents / Q000494:pharmacology; D000924:Anticholesteremic Agents / Q000494:pharmacology* / Q000627:therapeutic use; D050197:Atherosclerosis / Q000188:drug therapy* / Q000517:prevention & control*; D001794:Blood Pressure / Q000187:drug effects; D050218:Body Fat Distribution; D008076:Cholesterol, HDL / Q000097:blood / Q000378:metabolism; D003327:Coronary Disease / Q000517:prevention & control*; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D006801:Humans; D007004:Hypoglycemic Agents / Q000494:pharmacology* / Q000627:therapeutic use; D050356:Lipid Metabolism; D008264:Macrophages / Q000378:metabolism; D000077205:Pioglitazone; D058226:Plaque, Atherosclerotic / Q000188:drug therapy / Q000517:prevention & control; D045162:Thiazolidinediones / Q000494:pharmacology* / Q000627:therapeutic use; D014463:Ultrasonography
chemical_list: D000893:Anti-Inflammatory Agents; D000924:Anticholesteremic Agents; D008076:Cholesterol, HDL; D007004:Hypoglycemic Agents; D045162:Thiazolidinediones; D000077205:Pioglitazone