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In addition to improving insulin sensitivity, pioglitazone treatment improves endothelial function in conduit arteries and decreases plasma levels of C-reactive protein.
That, according to findings presented at the 13th International Symposium on Atherosclerosis.
Dr. F.M.A.C. Martens, University Medical Center Utrecht, Internal Medicine, Section of Vascular Medicine and Diabetology, Utrecht, The Netherlands.
Patients with type 2 diabetes often suffer from large vessel atherosclerotic disease. Consequently, Dr. Marten and associates examined the effects of a short term treatment of pioglitazone on endothelial function and C-reactive protein — two important predictors of adverse cardiovascular events — in diabetics.
Pioglitazone, an agonist of the peroxisome proliferator activating receptor gamma, works as an anti-hyperglycaemic agent targeting the metabolic syndrome.
In a randomized, crossover, placebo controlled, double blind trial, 20 men with type 2 diabetes were treated with pioglitazone 30 mg a day for 4 weeks or a placebo. Each patient had been previously treated with oral antihyperglycaemic drugs. None had received vasoactive medication.
Participants were evaluated for flow mediated dilation and forearm plethysmography. Flow mediated dilation was used to determine the large vessel response of the brachial artery on shear stress. Forearm plethysmography was used to measure the effect on resistance vessel responses of intra-arterial administration of serotonin, nitroprusside, and NG-monomethyl-L-arginine.
After comparing the treatment and placebo groups, Dr. Martens and associated found a significant increase in endothelial-dependent flow mediated dilation among the pioglitazone treated patients.
Endothelial-independent nitroprusside-induced vasodilation remained the same even after treatment with pioglitazone. There were no significant differences in forearm plethysmography of the patients who received pioglitazone and those who received the placebo. Plasma insulin concentration, free fatty acids, and C-reactive protein decreased in the treatment group.
Dr. Martens explained that pioglitazone has a three prong approach in reducing cardiovascular disease. It has beneficial vascular effects, metabolic effects such as lowering insulin and free fatty acids, and anti-inflammatory effects such as decreasing C-reactive protein.
[Study title: Pioglitazone improves conduit artery endothelial function and decreases plasma CRP levels in type 2 diabetes. Abstract 3P-0705]==============================
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