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Efecto de la pioglitazona en comparación con la glimepirida en el espesor de la carótida íntima-media en la diabetes
Theodore Mazzone1, Peter M Meyer, Steven B Feinstein
1Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Illinois College of Medicine, Chicago 60612, USA. tmazzone@uic.edu
JAMA
|November 15, 2006
Resumen
La pioglitazona ralentizó significativamente la progresión del espesor íntima-media de la arteria carótida (CIMT) en pacientes con diabetes mellitus tipo 2 (DM) en comparación con la glimepirida durante 18 meses. Esto sugiere que la pioglitazona puede ofrecer beneficios cardiovasculares en la DM tipo 2.
Área de la Ciencia:
- Medicina Cardiovascular La medicina cardiovascular es una especialidad de la salud.
- Endocrinología Endocrinología.
- Farmacología Farmacología.
Sus antecedentes:
- El espesor íntima-medio de la arteria carótida (CIMT) es un indicador clave de la aterosclerosis y el riesgo cardiovascular, particularmente elevado en la diabetes mellitus tipo 2 (DM).
- Estudios previos a corto plazo sugirieron que las tiazolidinedionas, como la pioglitazona, pueden retrasar la progresión de la CIMT en pacientes diabéticos, pero los datos a largo plazo no fueron concluyentes.
Objetivo del estudio:
- Para comparar la eficacia de la pioglitazona frente a la glimepirida en la alteración de la CIMT de la arteria carótida común en pacientes con DM tipo 2.
- Evaluar el impacto a largo plazo de estos agentes antidiabéticos en la progresión de la aterosclerosis subclínica.
Principales métodos:
- Un ensayo aleatorizado, doble ciego y multicéntrico que involucró a 462 adultos con DM tipo 2 durante 72 semanas.
- Los participantes recibieron pioglitazona (15-45 mg/día) o glimepirida (1-4 mg/día) como comparador activo.
- Los cambios en la CIMT media de la pared posterior se midieron utilizando tecnología automatizada de detección de bordes a partir de imágenes de ultrasonido carotídeo.
Principales resultados:
- La pioglitazona demostró una progresión significativamente más lenta de la CIMT media en comparación con la glimepirida a las 72 semanas (diferencia: -0.013 mm; P = .02).
- La progresión de la CIMT máxima también se redujo significativamente con pioglitazona versus glimepirida (diferencia: -0.024 mm; P = .008).
- Los efectos beneficiosos de la pioglitazona en la CIMT fueron consistentes en varios subgrupos de pacientes.
Conclusiones:
- Durante un período de 18 meses, la pioglitazona ralentizó efectivamente la progresión de la CIMT en pacientes con DM tipo 2 en comparación con la glimepirida.
- Estos hallazgos apoyan un papel potencial de la pioglitazona en la mitigación de la aterosclerosis subclínica en esta población de pacientes.
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