Lipoprotein effects of different thiazolidinediones in clinical practice

To investigate and compare the effects of troglitazone and rosiglitazone on plasma lipoproteins in patients with type 2 diabetes mellitus and dyslipidemia.

This cohort study was conducted in the Diabetes Clinic of the University of Alabama. We identified and studied 18 patients with type 2 diabetes and dyslipidemia first treated with troglitazone (600 mg/day) and then transferred to rosiglitazone therapy (8 mg/day).

By lowering insulin resistance, thiazolidinediones have common effects on lipoproteins; however, these drugs may have important differences in their effects on individual lipid particles. In our patients, both troglitazone and rosiglitazone increased low-density lipoprotein (LDL) levels; however, only rosiglitazone significantly changed the LDL particle size to the larger, less atherogenic LDL particle. Similarly, both troglitazone and rosiglitazone increased high-density lipoprotein (HDL) concentrations; however, although troglitazone increased only HDL(3), rosiglitazone also significantly increased the larger, more cardioprotective HDL(2) particle. Furthermore, only troglitazone increased Lp(a) significantly. In contrast, rosiglitazone and not troglitazone significantly increased triglycerides.

Small but significant differences exist in the effects of different thiazolidinediones on lipoproteins in patients with type 2 diabetes. Overall, the changes in lipoprotein profile induced by rosiglitazone therapy seem to have less atherogenic potential than those resulting from the use of troglitazone.