title: Pioglitazone improves the cardio-ankle vascular index in patients with type 2 diabetes mellitus treated with metformin.
abstract: BACKGROUND
  Type 2 diabetes is known to be associated with elevated cardiovascular mortality. Pioglitazone improves blood pressure (BP) and pulse wave velocity (PWV), which is an arterial stiffness parameter. Arterial stiffness is closely associated with cardiovascular disease. However, PWV is correlated with BP. The cardio-ankle vascular index (CAVI) reflects arterial stiffness independent of BP. Pioglitazone improves PWV but reduces blood pressure. The aim of this study was to re-evaluate the effect of pioglitazone on arterial stiffness with CAVI.
  
  
  METHODS
  Sixty patients with type 2 diabetes mellitus and already on 500 mg/day of metformin received add-on therapy of pioglitazone 15 mg/day or glimepiride 1 mg/day for 6 months, during which time changes in their metabolic parameters and CAVI were observed.
  
  
  RESULTS
  After 6 months of treatment, both pioglitazone (n=30) and glimepiride (n=30) improved fasting blood glucose and glycated hemoglobin. The changes in fasting blood glucose and glycated hemoglobin between the two groups were greater in the pioglitazone group. Systolic and diastolic BP was decreased in both groups, with no significant between-group differences. Only pioglitazone increased serum adiponectin levels, and the change in adiponectin between the pioglitazone and glimepiride groups was significantly different. CAVI was decreased significantly by pioglitazone but remained unchanged after treatment with glimepiride. The change in CAVI between the two groups was significantly different.
  
  
  CONCLUSIONS
  These results suggest that pioglitazone improves CAVI, a BP-independent arterial stiffness parameter, in patients with type 2 diabetes mellitus treated with metformin.
authors.affiliation: Center for Diabetes, Endocrinology and Metabolism, Sakura Hospital, Toho University Medical Center, Chiba, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ohira
authors.affiliation: Center for Diabetes, Endocrinology and Metabolism, Sakura Hospital, Toho University Medical Center, Chiba, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamaguchi
authors.affiliation: Center for Diabetes, Endocrinology and Metabolism, Sakura Hospital, Toho University Medical Center, Chiba, Japan.
authors.forename: Atsuhito
authors.initials: A
authors.lastname: Saiki
authors.affiliation: Center for Diabetes, Endocrinology and Metabolism, Sakura Hospital, Toho University Medical Center, Chiba, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Ban
authors.affiliation: Center for Diabetes, Endocrinology and Metabolism, Sakura Hospital, Toho University Medical Center, Chiba, Japan.
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Kawana
authors.affiliation: Center for Diabetes, Endocrinology and Metabolism, Sakura Hospital, Toho University Medical Center, Chiba, Japan.
authors.forename: Ayako
authors.initials: A
authors.lastname: Nagumo
authors.affiliation: Department of Clinical Laboratory Medicine, Sakura Hospital, Toho University Medical Center, Chiba, Japan.
authors.forename: Takeyoshi
authors.initials: T
authors.lastname: Murano
authors.affiliation: Department of Vascular Function, Sakura Hospital, Toho University Medical Center, Chiba, Japan.
authors.forename: Kohji
authors.initials: K
authors.lastname: Shirai
authors.affiliation: Center for Diabetes, Endocrinology and Metabolism, Sakura Hospital, Toho University Medical Center, Chiba, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Tatsuno
keywords: arterial stiffness; biguanide; blood pressure; cardiovascular disease; sulfonylurea; thiazolidinediones
references.citation: Int J Cardiol. 2003 Feb;87(2-3):193-201
references.pmid: 12559540
references.citation: Metabolism. 2011 Jan;60(1):78-85
references.pmid: 20667560
references.citation: Am Heart J. 2006 Jul;152(1):27-38
references.pmid: 16824829
references.citation: Exp Clin Endocrinol Diabetes. 2009 Nov;117(10):593-9
references.pmid: 19924605
references.citation: Lancet. 1998 Sep 12;352(9131):854-65
references.pmid: 9742977
references.citation: J Clin Lab Anal. 1997;11(2):82-6
references.pmid: 9058241
references.citation: BMJ. 2000 Aug 12;321(7258):405-12
references.pmid: 10938048
references.citation: Atherosclerosis. 2005 Oct;182(2):209-17
references.pmid: 16159593
references.citation: J Atheroscler Thromb. 2006 Apr;13(2):101-7
references.pmid: 16733298
references.citation: J Atheroscler Thromb. 2011;18(1):49-55
references.pmid: 21071883
references.citation: Diabetes Care. 2000 Jul;23(7):962-8
references.pmid: 10895847
references.citation: Circ J. 2007 Nov;71(11):1710-4
references.pmid: 17965489
references.citation: Lancet. 1998 Sep 12;352(9131):837-53
references.pmid: 9742976
references.citation: Diab Vasc Dis Res. 2008 Sep;5(3):157-67
references.pmid: 18777488
references.citation: Diabetes Res Clin Pract. 2007 Apr;76(1):93-101
references.pmid: 16956692
references.citation: JAMA. 2006 Dec 6;296(21):2572-81
references.pmid: 17101640
references.citation: Clin Chim Acta. 1974 Mar 15;51(2):173-82
references.pmid: 4133339
references.citation: Circ J. 2007 Jan;71(1):89-94
references.pmid: 17186984
references.citation: Clin Chem. 2011 Aug;57(8):1196-200
references.pmid: 21697499
references.citation: Clin Chim Acta. 1993 Jul 16;216(1-2):113-23
references.pmid: 8222262
references.citation: Obes Res Clin Pract. 2013 Mar-Apr;7(2):e139-e145
references.pmid: 24331775
references.citation: Biochim Biophys Acta. 1994 Nov 17;1215(1-2):121-5
references.pmid: 7947993
references.citation: Int J Clin Pract. 2010 Dec;64(13):1796-801
references.pmid: 20946343
references.citation: Diabetes. 2005 Aug;54(8):2460-70
references.pmid: 16046315
references.citation: J Clin Endocrinol Metab. 2001 May;86(5):1930-5
references.pmid: 11344187
references.citation: Diabetes Res Clin Pract. 1999 Oct;46(1):35-41
references.pmid: 10580614
references.citation: JAMA. 1988 Oct 7;260(13):1917-21
references.pmid: 3418853
references.citation: Circ Res. 2010 Oct 15;107(8):953-8
references.pmid: 20798360
references.citation: Circ J. 2008 Apr;72(4):598-604
references.pmid: 18362432
references.citation: JAMA. 2008 Apr 2;299(13):1561-73
references.pmid: 18378631
references.citation: Eur Heart J Acute Cardiovasc Care. 2014 Mar;3(1):10-7
references.pmid: 24337918
references.citation: PLoS One. 2013 Oct 08;8(10):e75535
references.pmid: 24116054