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A diabetes medication used to improve insulin sensitivity may also slow thickening of arterial walls in diabetic patients, according to a study posted online by JAMA. The study was presented at the American Heart Association Scientific Session and will be published in the December 6 JAMA.

Diabetics who cannot produce insulin or respond to insulin have a higher risk for myocardial infarction. Controlling blood pressure and lowering low-density lipoprotein (LDL) cholesterol levels have been shown to lower risk but diabetes patients still have a increased risk for cardiovascular complications.

Theodore Mazzone, M.D., of the University of Illinois College of Medicine, and colleagues studied the effects of pioglitazone in 462 adults with type 2 diabetes in Chicago (2003 – 2006). The average age of the participants was 60 and included 289 men and 173 women. The participants either received a daily dose of pioglitazone or of glimepiride (another diabetes medication).

Ultrasound studies of the carotid arteries were done at the initiation of the study, and at 24, 48 and 72 weeks. The ultrasound quantified middle layer thickness of the carotid arteries,  called carotid artery intima-media thickness (CIMT). Glycosolated hemoglobin (HbA1c) levels, blood pressure, blood cholesterol levels, and adverse events were also measured throughout the study.

At baseline, the average CIMT was similar in the pioglitazone group and the glimepiride group (.771 millimeters vs. .779 millimeters). At 72-weeks into the study, the CIMT of patients in the glimepiride group increased by an average of .012 millimeters, while the average CIMT in the pioglitazone group decreased by .001 millimeters.

Blood pressure changes were not significantly different between the two groups. However, by week 48, HbA1c levels were significantly lower in the pioglitazone group compared to the glimepiride group.

Another  difference between the groups was increased high-density lipoprotein (HDL) cholesterol levels  in the pioglitazone group by week 24. The researchers concluded that lowering HbA1c and/or increasing HDL levels may represent potential mechanisms by which pioglitazone reduces artery thickness. The authors also note that thiazolidinediones (drug class of pioglitazone) may have a direct impact on the vessel wall that reduces the number of major cardiovascular events.


JAMA Media Release

Effect of Pioglitazone Compared With Glimepiride on Carotid Intima-Media Thickness in Type 2 Diabetes. JAMA. 2006;296:(doi:10.1001/jama.296.21.joc60158).

About the Author:

Jeanne Bohm, Ph.D. is a cancer biologist by training, a medical writer and an
experienced science educator.

The author has no financial relationship to any of the companies listed in the article.

Topics #carotid artery stenosis #diabetes #insulin #JAMA #pioglitazone