Abstract 5052: Lowering of the Triglyceride/HDL Cholesterol Ratio Predicts the Benefit of Pioglitazone on Progression of Coronary Atherosclerosis in Diabetic Patients
Administration of the PPAR-γ agonist pioglitazone has been reported to arrest progression of coronary atherosclerosis in patients with diabetes mellitus. This study investigated the relationship between changes in lipid levels and the impact of therapy on plaque progression. 360 type 2 diabetes patients with angiographic coronary artery disease were treated with glimepiride or pioglitazone for 18 months in the PERISCOPE study. The relationship between changes in lipid levels and progression of coronary atherosclerosis measured by serial intravascular ultrasound was investigated. Treatment with pioglitazone had a favorable effect on systemic levels of HDL cholesterol (+16.0%), triglycerides (−15.3%) and the triglyceride/HDL cholesterol ratio (−27.8%). Significant correlations were observed between changes in the triglyceride/HDL cholesterol ratio and changes in both percent atheroma volume (PAV; r=0.20, p=0.009) and total atheroma volume (TAV; r=0.18, p=0.02) in pioglitazone treated patients. Larger reductions in the triglyceride/HDL cholesterol ratio were observed in pioglitazone treated patients demonstrating substantial plaque regression (>5% reduction in PAV) compared with progression (>5% increase in PAV, −34.1 vs. −21.5%, p=0.046). Increasing tertiles of percent change in HDL cholesterol and apoA-I and decreasing tertiles of percent change in triglycerides, apoB and the triglyceride/HDL cholesterol ratio were associated with a beneficial impact on atheroma progression (Table⇓). On multivariable analysis, the change in triglyceride/HDL cholesterol ratio remained an independent predictor of the benefit of pioglitazone on progression of both PAV (p=0.04) and TAV (p=0.04). Lowering of the triglyceride/HDL cholesterol ratio is an independent predictor of the benefit of pioglitazone on progression of coronary atherosclerosis in diabetic patients with coronary artery disease.