title: Pioglitazone, a peroxisome proliferator-activated receptor γ activator, suppresses coronary spasm.
abstract: OBJECTIVE
  We examined whether a peroxisome proliferator-activated receptor γ (PPAR-γ) agonist, pioglitazone, suppresses coronary spasm.
  
  
  BACKGROUND
  Patients with coronary spastic angina (CSA) also have endothelial dysfunction and inflammation. Activation of PPAR-γ improves endothelial dysfunction and inflammation.
  
  
  METHODS
  The study participants included 73 consecutive CSA patients (47 men and 26 women, mean age 63.6±10.4 years) who were admitted to our institution with a suspicion of CSA because of episodes of chest discomfort occurring mostly at rest in whom coronary spasm was induced by an intracoronary acetylcholine injection and a repeat acetylcholine provocation injection was administered after 6 months of follow-up. Thirty-six of the patients were administered pioglitazone15-30 mg/day added on calcium channel blockers (CCBs) (pioglitazone group) and 37 were administered CCBs alone (control group). Clinical and laboratory data were also examined before and after 6 months of follow-up and the results between the two groups were compared.
  
  
  RESULTS
  Coronary spasm was suppressed in 18/36 patients (50.0%) in the pioglitazone group (P<0.001) and 8/37 patients (21.6%) in the control group (P=0.008) after 6 months of treatment. Coronary spasm was thus significantly reduced in the pioglitazone group compared with the control group (P=0.011). The levels of total white blood cell count and high-sensitivity C-reactive protein decreased significantly (P<0.001 and P<0.001, respectively) in the pioglitazone group, whereas these levels did not differ in the control group (P=0.15 and 0.39, respectively) after the treatment.
  
  
  CONCLUSIONS
  Pioglitazone added on CCBs significantly reduced coronary spasm compared with CCBs alone after 6 months of treatment. Pioglitazone may thus prove to be a novel therapy for coronary spasm.
authors.affiliation: aDivision of Cardiovascular Medicine, Kumamoto Kinoh Hospital, Kumamoto Aging Research Institute, Kumamoto City bDepartment of Internal Medicine, Division of Cardiology, The Jikei University School of Medicine, Tokyo cDepartment of Cardiology, Nagoya University School of Medicine, Nagoya, Japan.
authors.forename: Sumio
authors.initials: S
authors.lastname: Morita
authors.forename: Yuji
authors.initials: Y
authors.lastname: Mizuno
authors.forename: Eisaku
authors.initials: E
authors.lastname: Harada
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kashiwagi
authors.forename: Michihiro
authors.initials: M
authors.lastname: Yoshimura
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Yasue
mesh_terms: D000109:Acetylcholine; D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control*; D003331:Coronary Vessels / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D047495:PPAR gamma / Q000819:agonists* / Q000378:metabolism; D010865:Pilot Projects; D000077205:Pioglitazone; D045162:Thiazolidinediones / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D002121:Calcium Channel Blockers; D047495:PPAR gamma; D045162:Thiazolidinediones; D014665:Vasodilator Agents; D000109:Acetylcholine; D000077205:Pioglitazone