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on July 15, 2002

Circulation. 2002
Published online before print July 15, 2002, doi: 10.1161/01.CIR.0000025403.20953.23
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Submitted on March 21, 2002
Revised on May 22, 2002
Accepted on May 23, 2002

Effect of Rosiglitazone Treatment on Nontraditional Markers of Cardiovascular Disease in Patients With Type 2 Diabetes Mellitus

Steven M. Haffner MD*, Andrew S. Greenberg MD, Wayde M. Weston PhD, Hongzi Chen PhD, Ken Williams MS, and Martin I. Freed MD

From University of Texas Health Science Center at San Antonio (S.M.H., K.W.), San Antonio, Tex; Tufts-New England Medical Center (A.S.G.), Boston, Mass; and GlaxoSmithKline (W.M.W., H.C., M.I.F.), Collegeville, Philadelphia, Pa.

* To whom correspondence should be addressed. E-mail: haffner{at}uthscsa.edu.

Background—Markers of systemic inflammation (eg, C-reactive protein [CRP] and interleukin-6 [IL-6]) have been proposed to be "nontraditional" risk factors for cardiovascular disease in patients with type 2 diabetes mellitus. Matrix metalloproteinase-9 (MMP-9) has been implicated in the pathogenesis of atherosclerotic plaque rupture, which raises the possibility of the use of MMP-9 levels as a marker for future myocardial infarction or unstable angina. In vitro and animal studies suggest that thiazolidinediones can reduce the expression of these markers. The purpose of this analysis was to determine whether rosiglitazone alters serum concentrations of CRP, IL-6, MMP-9, and white blood cell count (WBC) and to examine the relationship of these effects with demographic and disease variables.

Methods and Results—CRP, IL-6, MMP-9, and WBC were analyzed from stored frozen serum samples obtained from patients with type 2 diabetes who completed a 26-week randomized, double-blind, placebo-controlled study. After 26 weeks of rosiglitazone treatment, the percentage reductions in mean CRP, MMP-9, and WBC levels were statistically significant compared with baseline and placebo (P<0.01). The percentage reduction in mean IL-6 was small and similar in the rosiglitazone and placebo groups. The change in each inflammatory marker from baseline to week 26 was significantly correlated (P<0.05) with each of the other markers, as well as with the homeostasis model assessment estimate of insulin resistance.

Conclusions—Rosiglitazone reduces serum levels of MMP-9 and the proinflammatory marker CRP in patients with type 2 diabetes, which indicates potentially beneficial effects on overall cardiovascular risk.


Key words: atherosclerosis • cardiovascular diseases • diabetes mellitus • inflammation • risk factors




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S. Dhindsa, D. Tripathy, N. Sanalkumar, S. Ravishankar, H. Ghanim, A. Aljada, and P. Dandona
Free Fatty Acid-Induced Insulin Resistance in the Obese Is Not Prevented by Rosiglitazone Treatment
J. Clin. Endocrinol. Metab., September 1, 2005; 90(9): 5058 - 5063.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
J. Hetzel, B. Balletshofer, K. Rittig, D. Walcher, W. Kratzer, V. Hombach, H.-U. Haring, W. Koenig, and N. Marx
Rapid Effects of Rosiglitazone Treatment on Endothelial Function and Inflammatory Biomarkers
Arterioscler Thromb Vasc Biol, September 1, 2005; 25(9): 1804 - 1809.
[Abstract] [Full Text] [PDF]


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Diabetes CareHome page
Z. T. Bloomgarden
Second World Congress on the Insulin Resistance Syndrome: Hypertension, cardiovascular disease, and treatment approaches
Diabetes Care, August 1, 2005; 28(8): 2073 - 2080.
[Full Text] [PDF]


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DiabetesHome page
B. Staels and J.-C. Fruchart
Therapeutic Roles of Peroxisome Proliferator-Activated Receptor Agonists
Diabetes, August 1, 2005; 54(8): 2460 - 2470.
[Abstract] [Full Text] [PDF]


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Eur J EndocrinolHome page
I. Tarkun, B. Cetinarslan, E. Turemen, T. Sahin, Z. Canturk, and B. Komsuoglu
Effect of rosiglitazone on insulin resistance, C-reactive protein and endothelial function in non-obese young women with polycystic ovary syndrome
Eur. J. Endocrinol., July 1, 2005; 153(1): 115 - 121.
[Abstract] [Full Text] [PDF]


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Diabetes CareHome page
S. E. Inzucchi, F. A. Masoudi, Y. Wang, M. Kosiborod, J. M. Foody, J. F. Setaro, E. P. Havranek, and H. M. Krumholz
Insulin-Sensitizing Antihyperglycemic Drugs and Mortality After Acute Myocardial Infarction: Insights from the National Heart Care Project
Diabetes Care, July 1, 2005; 28(7): 1680 - 1689.
[Abstract] [Full Text] [PDF]


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Proc. Natl. Acad. Sci. USAHome page
H. Zhang, A. Zhang, D. E. Kohan, R. D. Nelson, F. J. Gonzalez, and T. Yang
Collecting duct-specific deletion of peroxisome proliferator-activated receptor {gamma} blocks thiazolidinedione-induced fluid retention
PNAS, June 28, 2005; 102(26): 9406 - 9411.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
A. Pfutzner, N. Marx, G. Lubben, M. Langenfeld, D. Walcher, T. Konrad, and T. Forst
Improvement of Cardiovascular Risk Markers by Pioglitazone Is Independent From Glycemic Control: Results From the Pioneer Study
J. Am. Coll. Cardiol., June 21, 2005; 45(12): 1925 - 1931.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
P. M. Ridker, D. A. Morrow, L. M. Rose, N. Rifai, C. P. Cannon, and E. Braunwald
Relative Efficacy of Atorvastatin 80 mg and Pravastatin 40 mg in Achieving the Dual Goals of Low-Density Lipoprotein Cholesterol <70 mg/dl and C-Reactive Protein <2 mg/l: An Analysis of the PROVE-IT TIMI-22 Trial
J. Am. Coll. Cardiol., May 17, 2005; 45(10): 1644 - 1648.
[Abstract] [Full Text] [PDF]


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CirculationHome page
M.R. Langenfeld, T. Forst, C. Hohberg, P. Kann, G. Lubben, T. Konrad, S.D. Fullert, C. Sachara, and A. Pfutzner
Pioglitazone Decreases Carotid Intima-Media Thickness Independently of Glycemic Control in Patients With Type 2 Diabetes Mellitus: Results From a Controlled Randomized Study
Circulation, May 17, 2005; 111(19): 2525 - 2531.
[Abstract] [Full Text] [PDF]


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Circ. Res.Home page
A. H. Berg and P. E. Scherer
Adipose Tissue, Inflammation, and Cardiovascular Disease
Circ. Res., May 13, 2005; 96(9): 939 - 949.
[Abstract] [Full Text] [PDF]


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British Journal of Diabetes & Vascular DiseaseHome page
B. Cariou, J.-C. Fruchart, and B. Staels
Review: Vascular protective effects of peroxisome proliferator-activated receptor agonists
The British Journal of Diabetes & Vascular Disease, May 1, 2005; 5(3): 126 - 132.
[Abstract] [PDF]


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DiabetesHome page
The Diabetes Prevention Program Research Group
Intensive Lifestyle Intervention or Metformin on Inflammation and Coagulation in Participants With Impaired Glucose Tolerance
Diabetes, May 1, 2005; 54(5): 1566 - 1572.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
S. B. Kritchevsky, M. Cesari, and M. Pahor
Inflammatory markers and cardiovascular health in older adults
Cardiovasc Res, May 1, 2005; 66(2): 265 - 275.
[Abstract] [Full Text] [PDF]


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Clin. DiabetesHome page
B. Kimmel and S. E. Inzucchi
Oral Agents for Type 2 Diabetes: An Update
Clin. Diabetes, April 1, 2005; 23(2): 64 - 76.
[Abstract] [Full Text] [PDF]


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J. Clin. Endocrinol. Metab.Home page
A. H. Xiang, R. K. Peters, S. L. Kjos, C. Ochoa, A. Marroquin, J. Goico, S. Tan, C. Wang, S. P. Azen, C.-r. Liu, et al.
Effect of Thiazolidinedione Treatment on Progression of Subclinical Atherosclerosis in Premenopausal Women at High Risk for Type 2 Diabetes
J. Clin. Endocrinol. Metab., April 1, 2005; 90(4): 1986 - 1991.
[Abstract] [Full Text] [PDF]


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Nephrol Dial TransplantHome page
E. M. Stuveling, S. J. L. Bakker, H. L. Hillege, P. E. de Jong, R. O. B. Gans, and D. de Zeeuw
Biochemical risk markers: a novel area for better prediction of renal risk?
Nephrol. Dial. Transplant., March 1, 2005; 20(3): 497 - 508.
[Full Text] [PDF]


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ANGIOLOGYHome page
N. P. Kadoglou, S. S. Daskalopoulou, D. Perrea, and C. D. Liapis
Matrix Metalloproteinases and Diabetic Vascular Complications
Angiology, March 1, 2005; 56(2): 173 - 189.
[Abstract] [PDF]


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Am. J. Physiol. Heart Circ. Physiol.Home page
E. L. Schiffrin
Peroxisome proliferator-activated receptors and cardiovascular remodeling
Am J Physiol Heart Circ Physiol, March 1, 2005; 288(3): H1037 - H1043.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
A. V. Finn, I. F. Palacios, A. Kastrati, and H. K. Gold
Drug-eluting stents for diabetes mellitus: A rush to judgment?
J. Am. Coll. Cardiol., February 15, 2005; 45(4): 479 - 483.
[Abstract] [Full Text] [PDF]


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CirculationHome page
F. A. Masoudi, S. E. Inzucchi, Y. Wang, E. P. Havranek, J. M. Foody, and H. M. Krumholz
Thiazolidinediones, Metformin, and Outcomes in Older Patients With Diabetes and Heart Failure: An Observational Study
Circulation, February 8, 2005; 111(5): 583 - 590.
[Abstract] [Full Text] [PDF]


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Diabetes and Vascular Disease ResearchHome page
J. W Chu, F. Abbasi, C. Lamendola, T. McLaughlin, G. M Reaven, and P. S Tsao
Effect of rosiglitazone treatment on circulating vascular and inflammatory markers in insulin-resistant subjects
Diabetes and Vascular Disease Research, February 1, 2005; 2(1): 37 - 41.
[Abstract] [PDF]


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Vasc MedHome page
S. S. Signorelli, G. Malaponte, M. Libra, L. D. Pino, G. Celotta, V. Bevelacqua, M. Petrina, G. S Nicotra, M. Indelicato, P. M Navolanic, et al.
Plasma levels and zymographic activities of matrix metalloproteinases 2 and 9 in type II diabetics with peripheral arterial disease
Vascular Medicine, February 1, 2005; 10(1): 1 - 6.
[Abstract] [PDF]


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Vasc MedHome page
A. Tedgui
The role of inflammation in atherothrombosis: implications for clinical practice
Vascular Medicine, February 1, 2005; 10(1): 45 - 53.
[Abstract] [PDF]


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J. Clin. Endocrinol. Metab.Home page
M. Recasens, A. Lopez-Bermejo, W. Ricart, J. Vendrell, R. Casamitjana, and J. M. Fernandez-Real
An Inflammation Score Is Better Associated with Basal than Stimulated Surrogate Indexes of Insulin Resistance
J. Clin. Endocrinol. Metab., January 1, 2005; 90(1): 112 - 116.
[Abstract] [Full Text] [PDF]


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ASH Education BookHome page
M. A. Crowther
Pathogenesis of Atherosclerosis
Hematology, January 1, 2005; 2005(1): 436 - 441.
[Abstract] [Full Text] [PDF]


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CirculationHome page
W.H. W. Tang and A. M. Lincoff
Diabetes, Coronary Intervention, and Platelet Glycoprotein IIb/IIIa Blockade: The Triad Revisited
Circulation, December 14, 2004; 110(24): 3618 - 3620.
[Full Text] [PDF]


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J Am Coll CardiolHome page
P. R. Moreno and V. Fuster
The year in atherothrombosis
J. Am. Coll. Cardiol., December 7, 2004; 44(11): 2099 - 2110.
[Full Text] [PDF]


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J. Clin. Endocrinol. Metab.Home page
G. Schernthaner, D. R. Matthews, B. Charbonnel, M. Hanefeld, P. Brunetti, and on Behalf of the Quarter Study Group
Efficacy and Safety of Pioglitazone Versus Metformin in Patients with Type 2 Diabetes Mellitus: A Double-Blind, Randomized Trial
J. Clin. Endocrinol. Metab., December 1, 2004; 89(12): 6068 - 6076.
[Abstract] [Full Text] [PDF]


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J. Lipid Res.Home page
A. C. Li and C. K. Glass
PPAR- and LXR-dependent pathways controlling lipid metabolism and the development of atherosclerosis
J. Lipid Res., December 1, 2004; 45(12): 2161 - 2173.
[Abstract] [Full Text] [PDF]


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Diabetes CareHome page
D. Choi, S.-K. Kim, S.-H. Choi, Y.-G. Ko, C.-W. Ahn, Y. Jang, S.-K. Lim, H.-C. Lee, and B.-S. Cha
Preventative Effects of Rosiglitazone on Restenosis After Coronary Stent Implantation in Patients With Type 2 Diabetes
Diabetes Care, November 1, 2004; 27(11): 2654 - 2660.
[Abstract] [Full Text] [PDF]


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Diabetes CareHome page
V. A. Fonseca, J. Diez, and D. B. McNamara
Decreasing Restenosis Following Angioplasty: The potential of peroxisome proliferator-activated receptor {gamma} agonists
Diabetes Care, November 1, 2004; 27(11): 2764 - 2766.
[Full Text] [PDF]