Effects of Thiazolidinediones on Coronary Artery Disease: Review

Kazuaki      Nishio; Youichi      Kobayashi

Abstract

Despite advances in the development of anti-diabetic agents and a greater focus on cardiovascular risk modification for patients with diabetes, cardiovascular disease remains the most common complication of type 2 diabetes. Coronary artery disease and atherosclerosis are cardiovascular disorders with endothelial dysfunction that are associated with increased circulating levels of inflammatory markers. Endothelial dysfunction is currently through to be not only a marker of vascular disease, but also to play an important role in atherosclerosis. Thiazolidinediones (TZDs), which activates peroxisome proliferators-activated receptor gamma (PPAR-γ), are a class of antidiabetes agents. PPAR-γ activation prevented coronary arteriosclerosis by its antiinflammatory effects. Some studies demonstrated that TZDs reduce restenosis after coronary stenting. Recent study demonstrated that treatment with pioglitazone resulted in a significantly lower rate of progression of coronary atherosclerosis in patients with type 2 diabetes and coronary artery disease. The PROactive study has suggested that the efficacy of pioglitazone reduces mortality in type 2 diabetes mellitus on the secondary endpoints. Recent study showed that pioglitazone treatment resulted in significant risk reduction in major adverse cardiac events in patients with advanced type 2 diabetes at high risk for cardiovascular events. TZDs improve endothelial dysfunction, prevent atherosclerosis, and significantly reduce the risk of cardiovascular disease. Some of the recent patent related to the field also discuss in this review article.

Keywords: Atherosclerosis, coronary artery disease, diabetes mellitus, endothelial dysfunction, thiazolidinediones

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