doi: 10.1161/01.CIR.0000054675.30348.9A
(Circulation. 2003;107:1350.)
© 2003 American Heart Association, Inc.
Clinician Update |
Glitazones and Heart Failure
Critical Appraisal for the Clinician
From the Division of Cardiac Surgery (C.W., R.D.W., P.W.M.F., S.V.) and the Division of Cardiology (P.L.), Toronto General Hospital, University of Toronto, Toronto, Canada.
Correspondence to Subodh Verma, MD, PhD, Division of Cardiac Surgery, Toronto General Hospital, EN 14-217, 200 Elizabeth St, Toronto, ON, Canada, M5G 2C4. E-mail subodh.verma@sympatico.ca
Key Words: heart failure • pharmacology • vasculatures
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
Mr S. is a 46-year-old East-Indian male with typical manifestations of the cardiovascular dysmetabolic syndrome of insulin resistance (type II diabetes, obesity, dyslipidemia, hypertension, and elevated levels of high-sensitivity C-reactive protein). His medications include ramipril, simvastatin, enteric-coated aspirin, metformin, and glyburide. He has no symptoms of cardiac ischemia or congestive heart failure and has preserved left ventricular function. Over the past few months his glycemic control has been inadequate, and a decision to initiate an insulin sensitizer (glitazone) is made. Treatment is initiated with rosiglitazone 4 mg twice daily, with marked improvement in glycemic control and other components of the cardiovascular dysmetabolic syndrome. Approximately 6 months after initiation of therapy, your junior resident receives a phone call from Mr S, who is extremely anxious and distraught about the possibility of developing heart failure on glitazone therapy. The resident and the patient request your expert opinion about the effects of glitazones on cardiac function and associated hemodynamics.
Insulin resistance has been increasingly recognized as a central metabolic disturbance predisposing a patient to hypertension, hyperlipidemia, premature atherosclerosis, left ventricular hypertrophy, and endothelial dysfunction.1 In addition to being a powerful risk marker for the development of cardiovascular disease, insulin resistance is also closely related to cardiac dysfunction and heart failure.2 Thiazolidinediones (TZD; glitazones) are peroxisome proliferator-activated receptor (PPAR) agonists that specifically augment insulin sensitivity and counter insulin resistance in patients with the cardiovascular dysmetabolic syndrome. Currently, there are 2 commercially available glitazones, rosiglitazone and pioglitazone. Troglitazone was withdrawn from the market because of
This article has been cited by other articles:
 |
|
 |
|
  M. Kindermann and M. Bohm Sweet hearts die earlier--lessons from CHARM Eur. Heart J., June 1, 2008; 29(11): 1342 - 1343. [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. Lincoff, K. Wolski, S. J. Nicholls, and S. E. Nissen Pioglitazone and Risk of Cardiovascular Events in Patients With Type 2 Diabetes Mellitus: A Meta-analysis of Randomized Trials JAMA, September 12, 2007; 298(10): 1180 - 1188. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. C. Granberry, J. B. Hawkins, and A. M. Franks Thiazolidinediones in patients with type 2 diabetes mellitus and heart failure Am. J. Health Syst. Pharm., May 1, 2007; 64(9): 931 - 936. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D.-H. Cho, Y. J. Choi, S. A. Jo, J. Ryou, J. Y. Kim, J. Chung, and I. Jo Troglitazone acutely inhibits protein synthesis in endothelial cells via a novel mechanism involving protein phosphatase 2A-dependent p70 S6 kinase inhibition Am J Physiol Cell Physiol, August 1, 2006; 291(2): C317 - C326. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Gomez-Garre, M. Herraiz, M. L. Gonzalez-Rubio, R. Bernal, P. Aragoncillo, A. Carbonell, J. J. Rufilanchas, and A. Fernandez-Cruz Activation of peroxisome proliferator-activated receptor-{alpha} and -{gamma} in auricular tissue from heart failure patients Eur J Heart Fail, March 1, 2006; 8(2): 154 - 161. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Cekmen, M. Cesur, R. Cetinbas, P. Bedel, and O. Erdemli Acute Pulmonary Edema Due to Rosiglitazone Use in a Patient With Diabetes Mellitus J Intensive Care Med, January 1, 2006; 21(1): 47 - 50. [Abstract] [PDF]
|
|
|
|
 |
|
 W. C. Stanley, F. A. Recchia, and G. D. Lopaschuk Myocardial Substrate Metabolism in the Normal and Failing Heart Physiol Rev, July 1, 2005; 85(3): 1093 - 1129. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 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]
|
|
|
|
 |
|
 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]
|
|
|
|
 |
|
 S. Verma, M. A. Kuliszewski, S.-H. Li, P. E. Szmitko, L. Zucco, C.-H. Wang, M. V. Badiwala, D. A.G. Mickle, R. D. Weisel, P. W.M. Fedak, et al. C-Reactive Protein Attenuates Endothelial Progenitor Cell Survival, Differentiation, and Function: Further Evidence of a Mechanistic Link Between C-Reactive Protein and Cardiovascular Disease Circulation, May 4, 2004; 109(17): 2058 - 2067. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C.-H. Wang, N. Ciliberti, S.-H. Li, P. E. Szmitko, R. D. Weisel, P. W.M. Fedak, M. Al-Omran, W.-J. Cherng, R.-K. Li, W. L. Stanford, et al. Rosiglitazone Facilitates Angiogenic Progenitor Cell Differentiation Toward Endothelial Lineage: A New Paradigm in Glitazone Pleiotropy Circulation, March 23, 2004; 109(11): 1392 - 1400. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Singh Rosiglitazone and Heart Failure: Long-Term Vigilance Journal of Cardiovascular Pharmacology and Therapeutics, March 1, 2004; 9(1): 21 - 25. [Abstract] [PDF]
|
|
|
|
 |
|
 E. L. Schiffrin, F. Amiri, K. Benkirane, M. Iglarz, and Q. N. Diep Peroxisome Proliferator-Activated Receptors: Vascular and Cardiac Effects in Hypertension Hypertension, October 1, 2003; 42(4): 664 - 668. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. P. Kennedy Do Thiazolidinediones Cause Congestive Heart Failure? Mayo Clin. Proc., September 1, 2003; 78(9): 1076 - 1077. [PDF]
|
|
|
|
|
|
J. B. Buse Glitazones and Heart Failure: Critical Appraisal for the Clinician Circulation, August 26, 2003; 108 (8): e57 - e57. [Full Text] [PDF]
|
|