Abstract 3304: Effects Of Pioglitazone On Myocardial Blood Flow And Glucose Utilization In Non-diabetic Patients With Familial Combined Hyperlipidemia
Background and Objectives Patients with risk factors for CAD have abnormalities in the control of myocardial blood flow (MBF) due to coronary microvascular dysfunction which are often associated with abnormal myocardial glucose utilization (MGU). Familial combined hyperlipidemia (FCHL) is a complex genetic disorder conferring a high risk of premature CAD and characterized by insulin resistance. Aim of this study was to examine whether treatment with pioglitazone would improve MGU and MBF in non-diabetic FCHL patients.
Methods and Results We undertook a randomized, double blind, placebo-controlled study in 26 FCHL patients (24 men; mean age 52 ± 6 years) treated with conventional lipid lowering therapy to which pioglitazone or matching placebo were added (30 mg daily for 4 weeks, followed by 45 mg daily for 12 weeks). MGU during euglycemic hyperinsulinemic clamp, resting and hyperemic (adenosine) MBF were measured with positron emission tomography using F-18-fluorodeoxyglucose and O-15-labeled water respectively. MGU and MBF were measured at baseline and after 4 months of treatment. Pioglitazone significantly improved whole body glucose disposal (+33%; p=0.004), MGU (+31%; p=0007) and resting MBF (+13%; p=0.008) while no changes were observed in the placebo group. Furthermore, in the pioglitazone group, HDL cholesterol and adiponectin were significantly increased while serum insulin was reduced.
Conclusions The addition of pioglitazone in FCHL patients treated with conventional lipid lowering therapy led to significant improvements in MGU and MBF with a favourable effect on blood lipid and metabolic parameters.