Abstract 11818: Long-Term Administration of Pioglitazone Added to Statin Reverses Vasomotor Dysfunction of Coronary Arteries Irrespective of Improvements in Diabetic Status
Background: Effects of insulin sensitizing agents on coronary artery pathophysiology have marked attention, however the long-term effects remain uncertain. We previously reported clinical effects of pioglitazone, and we also demonstrated adverse prognostic impacts of vasomotor dysfunction in coronary arteries. This study evaluated long-term effects of pioglitazone, an insulin sensitizing agent, upon vasomotor responses of coronary arteries that are frequently affected by diabetes mellitus in patients treated with statin, one of the best possible antiatherosclerotic therapies.
Methods:Twenty-six type-2 diabetic patients treated with statin were randomized where they received pioglitazone (15-30mg/day) (group-P), or they received antidiabetic therapy without thiazolidinedione for more than 1 year (group-C). We measured reactive changes in coronary blood flow (coronary flow reserve: CFR) or reactive endothelium-dependent dilatation (FMD) of coronary arteries to infusion of ATP (50μ g) into the study (normal or minimally diseased) left coronary artery. CFR (maximal hyperemic flow-baseline flow/baseline flow) was quantified by coronary angiography and intracoronary doppler-guidewire. Changes in CFR, FMD, and other clinical variables were compared between the two study groups.
Results: All the enrolled patients manifested good compliance to the treatment and improvements in some of metabolic variables represented by HbA1c in group-P (n=13). CFR significantly increased in group-P but not in group-C (group-P versus group-C: from 170±83% to 238±95%, p=0.01, versus, from 176±64% to 170±66%, p=0.24). FMD also significantly increased in group-P (from 3.9±1.8% to 7.5±1.6% p<0.01) and remained unchanged in group-C (from 4.0±1.7% to 4.0±2.0%, p=0.81). Changes of CFR or FMD in group-P did not significantly correlate to those of HbA1c (CFR: r=0.19, p=0.60, FMD: r=0.20, p=0.56).
Conclusion:This study suggests that long-term treatment with pioglitazone, added to standard antiatherosclerotic therapies with a statin, improves vasomotion of coronary arteries irrespective of diabetic status, which may have beneficial potentials for management of patients with coronary artery disease and type-2 diabetes mellitus receiving statin.
- © 2012 by American Heart Association, Inc.