Cardiovascular disease and benefits of thiazolidinediones

Thiazolidinediones (TZDs) directly improve insulin resistance and appear to preserve beta-cell function. Research has demonstrated beneficial changes in several cardiovascular risk factors, including decreased levels of proinsulin, free fatty acids, diastolic blood pressure, and microalbuminuria, as well as improvement in lipid parameters. TZDs decrease plasminogen activator inhibitor type 1, inhibit vascular smooth muscle cell proliferation, reduce carotid artery intimal-medial thickness, and improve endothelial function. These actions directly improve the vasculature and should decrease cardiovascular risk. Atherosclerosis is an inflammatory process, and TZDs reduce inflammatory markers, such as C-reactive protein, monocyte chemoattractant-1, and p47phox. The data suggest that TZDs may reduce the risk of cardiovascular disease when used in patients with type 2 diabetes.