Abstract 571: Pioglitazone but Not Glimepiride Decreased Carotid Plaque Inflammation in Type 2 Diabetes: A Randomized Prospective Study Using Serial FDG-PET/CT
Background: Proactive Stroke Study demonstrated pioglitazone, a insulin sensitizer, remarkably reduced the incidence of stroke (> 50%). It was possible that pioglitazone stabilized carotid plaque because of its anti-inflammatory properties, resulting in the decrease in stroke. We have reported that with serial FDG-PET/CT we are able to visualize inflammatory plaques and reduction of its inflammation by statin. Purpose: To assess whether pioglitazone could resolve carotid atherosclerotic inflammation by using serial FDG-PET/CT imaging in patients with type 2 diabetes.
Methods and Results: Twenty-seven patients with type 2 diabetes (70±7 years of age; 21 males, 6 females), who underwent hybrid PET/CT and had vascular FDG uptake, were randomized to receive pioglitazone (n= 14) or glimepiride (n= 13) for 4-month. Carotid artery FDG uptake was quantified by target-to-background ratio (TBR). After 4 months both drugs equally reduced HbA1c. Pioglitazone decreased hsCRP (ΔhsCRP, −0.37±0.02mg/L, p<.01) and TBR (ΔTBR, −0.25±0.08, p<.02) but glimepiride did not (ΔTBR, 0.11±0.11, ns). The decreases in TBR were correlated with the increases in HDL (p<.05).
CONCLUSIONS: In patients with type 2 diabetes, pioglitazone decreased hsCRP and FDG uptake in carotid atherosclerosis. Our findings suggest that the remarkable reduction stroke by pioglitazone may be due to its anti-inflammatory effects on carotid plaques.