Abstract 3723: Pattern Of Arterial Remodeling In Association With Halting Progression Of Coronary Atherosclerosis With Pioglitazone In Diabetic Patients: Insights From The Periscope Study
Background: Intravascular ultrasound has characterized accelerated progression of coronary atherosclerosis and impaired compensatory remodeling in patients with diabetes mellitus. Administration of the PPAR-γ agonist pioglitazone has been reported to arrest progression of coronary atherosclerosis in diabetic patients. Serial changes in vascular dimensions in patients treated with anti-diabetic therapies have not been previously reported.
Methods: Changes in vascular dimensions were investigated in 360 type 2 diabetes patients who were treated with either glimepiride or pioglitazone for a maximum for 18 months in the PERISCOPE study. The relationship between changes in atheroma volume and changes in both the external elastic membrane (EEM) and lumen were characterized.
Results: Administration of pioglitazone vs. glimepiride was associated with favorable effects on progression of percent atheroma volume (−0.16±0.21 vs. ±0.73±0.20%, p=0.002) and total atheroma volume (−5.5±1.6 vs. −1.5±1.5 mm3, p=0.06). Comparable reductions in EEM volume were observed in glimepiride (−14.3±2.8 mm3, p<0.0001) and pioglitazone (−10.5±2.9 mm3, p=0.0004) treated patients (p=0.35 between groups). In contrast, a trend towards greater reduction in lumen volume was observed in glimepiride (−12.7±2.0 mm3, p<0.0001) than pioglitazone (−5.1±2.1 mm3, p=0.01) treated patients (p=0.008 between groups). Stronger correlations were observed between changes in atheroma volume and the EEM than the lumen in both glimepiride (EEM r=0.74, p<0.01 and lumen r=0.29, p<0.01) and pioglitazone (EEM r=0.72, p<0.01 and lumen r=0.25, p<0.01) treated patients. Similar patterns of serial remodeling were observed regardless of use of insulin and degree of glycemic control.
Conclusion: Beneficial effects of pioglitazone on progression of coronary atherosclerosis are accompanied predominantly by less lumen constriction than observed in glimepiride treated patients.