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Published on: January 7, 2018

Cardiovascular risk and cardiometabolic protection: role of glitazones

Luisa Petrazzi1, Davide Grassi, Lorella Polidoro

  • 1Department of Internal Medicine and Public Health, University of L'Aquila, L'Aquila - Italy.

Journal of Nephrology
|November 27, 2008
PubMed

Insights

Thiazolidinediones (TZDs) show potential in managing type 2 diabetes and cardiovascular risk. Pioglitazone reduced secondary cardiovascular events, but further trials are needed to confirm TZD efficacy and safety in cardiometabolic protection.

Area of Science:

  • Cardiology
  • Endocrinology
  • Pharmacology

Background:

  • Type 2 diabetes mellitus (DMT2) significantly increases cardiovascular risk, making cardiometabolic protection a key treatment goal.
  • Thiazolidinediones (TZDs) are utilized for DMT2 treatment and have been investigated for cardiovascular prevention.
  • Previous studies like Troglitazone in Prevention of Diabetes and Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication explored TZD effects on diabetes onset.

Purpose of the Study:

  • To investigate the role of pioglitazone in cardiovascular event prevention in patients with DMT2 and macrovascular disease.
  • To evaluate the cardiovascular safety and efficacy of rosiglitazone in ongoing and planned clinical trials.
  • To clarify the overall role of TZDs in managing cardiovascular outcomes in diabetic patients.

Main Methods:

  • The Prospective Pioglitazone Clinical Trial in Macrovascular events assessed pioglitazone's effect on primary and secondary cardiovascular endpoints in 5,238 DMT2 patients.
  • A meta-analysis by Nissen and Wolski examined rosiglitazone's impact on myocardial infarction and cardiovascular death risk.
  • The Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycemia in Diabetes (RECORD) trial is ongoing to further evaluate rosiglitazone's cardiovascular effects.

Main Results:

  • Pioglitazone did not affect the primary composite endpoint but significantly reduced the secondary endpoint (all-cause mortality, nonfatal myocardial infarction, and stroke) by 16% (p=0.027) compared to placebo.
  • The meta-analysis indicated rosiglitazone was associated with increased myocardial infarction risk (p=0.03) and borderline increased cardiovascular death risk (p=0.06).
  • Interim results from the RECORD trial have not shown significant differences in myocardial infarction or death rates between rosiglitazone and the control group.

Conclusions:

  • Pioglitazone demonstrated a benefit in reducing a composite of major adverse cardiovascular events in DMT2 patients with existing macrovascular disease.
  • Contradictory findings regarding rosiglitazone's cardiovascular safety necessitate further investigation.
  • Large-scale trials are essential to definitively establish the role of TZDs in cardiovascular outcomes for type 2 diabetes management.

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