title: Pilot study of pioglitazone and exercise training effects on basal myocardial substrate metabolism and left ventricular function in HIV-positive individuals with metabolic complications.
abstract: BACKGROUND
  Individuals with HIV infection and peripheral metabolic complications have impaired basal myocardial insulin sensitivity that is related to left ventricular (LV) diastolic dysfunction. It is unknown whether interventions shown to be effective in improving peripheral insulin sensitivity can improve basal myocardial insulin sensitivity and diastolic function in people with HIV and peripheral metabolic complications.
  
  
  OBJECTIVE
  In a pilot study, we evaluated whether the peroxisome proliferator-activated receptor-gamma (PPAR-γ) agonist pioglitazone or combined endurance and resistance exercise training improves basal myocardial insulin sensitivity and diastolic function in HIV+ adults with peripheral metabolic complications.
  
  
  METHODS
  Twenty-four HIV+ adults with metabolic complications including peripheral insulin resistance were randomly assigned to 4 months of pioglitazone (PIO; 30 mg/d) or supervised, progressive endurance and resistance exercise training (EXS; 90-120 min/d, 3 d/wk). Basal myocardial substrate metabolism was quantified by radioisotope tracer methodology and positron emission tomography (PET) imaging, and LV function was measured by echocardiography.
  
  
  RESULTS
  Twenty participants completed the study. Neither PIO nor EXS resulted in a detectable improvement in basal myocardial insulin sensitivity or diastolic function. Post hoc analyses revealed sample sizes of more than 100 participants are needed to detect significant effects of these interventions on basal myocardial insulin sensitivity and function.
  
  
  CONCLUSIONS
  PIO or EXS alone did not significantly increase basal myocardial insulin sensitivity or LV diastolic function in HIV+ individuals with peripheral metabolic complications.
authors: Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri.
authors: W Todd
authors: WT
authors: Cade
authors: Division of Geriatrics and Nutritional Science, Washington University School of Medicine, St. Louis, Missouri.
authors: Dominic N
authors: DN
authors: Reeds
authors: Division of Infectious Disease, Washington University School of Medicine, St. Louis, Missouri.
authors: E Turner
authors: ET
authors: Overton
authors: Department of Radiology, Washington University School of Medicine, St. Louis, Missouri.
authors: Pilar
authors: P
authors: Herrero
authors: Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri.
authors: Alan D
authors: AD
authors: Waggoner
authors: Division of Endocrinology, Metabolism, & Lipid Research, Washington University School of Medicine, St. Louis, Missouri.
authors: Erin
authors: E
authors: Laciny
authors: Division of Endocrinology, Metabolism, & Lipid Research, Washington University School of Medicine, St. Louis, Missouri.
authors: Coco
authors: C
authors: Bopp
authors: Division of Endocrinology, Metabolism, & Lipid Research, Washington University School of Medicine, St. Louis, Missouri.
authors: Sherry
authors: S
authors: Lassa-Claxton
authors: Department of Radiology, Washington University School of Medicine, St. Louis, Missouri.
authors: Robert J
authors: RJ
authors: Gropler
authors: Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri.
authors: Linda R
authors: LR
authors: Peterson
authors: Division of Endocrinology, Metabolism, & Lipid Research, Washington University School of Medicine, St. Louis, Missouri.
authors: Kevin E
authors: KE
authors: Yarasheski
mesh_terms: D000328:Adult; D015444:Exercise; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007333:Insulin Resistance / Q000502:physiology; D008297:Male; D009206:Myocardium / Q000378:metabolism*; D010865:Pilot Projects; D000077205:Pioglitazone; D011446:Prospective Studies; D045162:Thiazolidinediones / Q000627:therapeutic use*; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D007004:Hypoglycemic Agents; D045162:Thiazolidinediones; D000077205:Pioglitazone
keywords: HIV; exercise; insulin resistance; left ventricular dysfunction; metabolic syndrome