2型糖尿病における頸動脈内膜介質の厚さに対するピオグリタゾンとグリメピリドの効果:ランダム化試験
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
まとめ
ピオグリタゾンは,グリメピリドと比較して,18ヶ月間にわたって,2型糖尿病 (DM) 患者における頸動脈内側筋厚さ (CIMT) の進行を著しく遅らせました. これは,ピオグリタゾンが2型糖尿病の心血管上の利点を提供することを示唆しています.
科学分野:
- 心血管医学 心血管医学
- エンドクリノロジー エンドクリノロジー
- 薬理学 薬理学とは
背景:
- 動脈動脈内膜の厚さ (CIMT) は,動脈硬化症と心血管疾患のリスクの重要な指標であり,特に2型糖尿病 (DM) で高くなっています.
- 以前の短期研究では,ピオグリタゾンのようなチアゾリジンダイオンは,糖尿病患者のCIMT進行を遅らせる可能性があるが,長期的なデータは不確実であった.
研究 の 目的:
- 2型DMの患者における常動脈CIMTの変化におけるピオグリタゾンの効果とグリメピリドの効果を比較する.
- これらの抗糖尿病薬のサブクリニック性動脈硬化症の進行に対する長期的な影響を評価する.
主な方法:
- ランダム化,ダブルブラインド,マルチセンター試験で,72週間にわたって2型DMの462人の成人を対象とした.
- 参加者は,活性比較薬としてピオグリタゾン (15-45 mg/d) またはグリメピリド (1-4 mg/d) を投与された.
- 背後の壁の平均CIMTの変化は,大動脈超音波画像からの自動エッジ検出技術を使用して測定されました.
主要な成果:
- ピオグリタゾンは72週間でグリメピリドと比較してCIMT平均の進行を著しく遅らせた (差異: -0.013 mm; P = .02).
- 最大CIMTの進行もピオグリタゾンとグリメピリドの投与で有意に減少した (差異: -0.024 mm; P = .008).
- CIMTに対するピオグリタゾンの有益な効果は,さまざまな患者サブグループで一貫していました.
結論:
- 18ヶ月間,ピオグリタゾンは,グリメピリドと比較して,2型DM患者のCIMTの進行を効果的に遅らせました.
- これらの発見は,この患者集団における亜臨床性動脈硬化症の緩和におけるピオグリタゾンの潜在的な役割を支持しています.
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