Effect of glitazones on the progression of coronary artery disease in type 2 diabetes patients

Abstract

The effect of thiazolidinediones (TZDs) on the progression of atherosclerosis in diabetes patients remains unclear. There has been heightened interest in recent years in this class of diabetes medications due to the non-glycemic lowering effects, such as altering lipids, inflammation and hematologic profiles. There have been several exciting studies over the past few years focused on the mechanism of action of the TZDs with respect to alteration in the cardio-metabolic profile in diabetes patients. New tools such as intravascular ultrasound have been used to follow plaques characteristics over time on a much more sensitive scale than has ever been possible in the past by coronary angiograms. These advances have enabled researchers to follow closely the macrovascular effects of different anti-atherosclerotic medications such as statins and TZDs. This article reviews the pathophysiology of atherosclerosis in diabetes, the role that TZDs play in this process and the imaging trials looking at the progression or regression of atherosclerosis in patients treated with TZDs.

Keywords: atherosclerosis; diabetes; thiazolidinediones.

Figure 1

Endothelial dysfunction-obesity hypothesis.

Figure 2

Peroxisome proliferative activated receptors (PPARs) clinical overview. This figure shows the overlapping activity of the PPARs. Clinically the current glucose-lowering agents and insulin sensitizers are PPARγ. PPARα compounds are primarily fibrates that reduce triglyceride levels and increase high-density lipoprotein cholesterol. PPARβ/δ is still experimental.

Figure 3

Intravascular ultrasound studies change from baseline in percent atheroma volume.