Patients with type-2 diabetes are at high risk of fatal and non-fatal myocardial infarction and stroke, these events are the main reason for their decreased life expectancy. There is indirect evidence that agonists of peroxisome proliferator-activated receptor-ã (PPAR-ã) could reduce macrovascular complications. Pioglitazone is one such agonist used to treat type-2 diabetes.
A recent study, published in the October issue of The Lancet, was conducted to ascertain whether pioglitazone reduces cardiovascular morbidity and mortality in patients with type-2 diabetes, and to assess the safety and tolerability of such treatment. The overall pattern of changes induced by pioglitazone suggests a general improvement in various risk factors, thus lowering heart risk.
A total of 5238 patients with type 2 diabetes who had evidence of macrovascular disease were enrolled in a long-term study to see if pioglitazone, could lower this risk in addition to its known function of controlling blood glucose levels. Half of the group was given pioglitazone, while the other was given a harmless look-alike called a placebo. Their health was monitored for nearly three years on average.
Those who took pioglitazone were 16% less likely to suffer a heart attack or stroke than the placebo group during this time, although they were also prone to gaining weight, which in itself is a source of cardiac stress.
This study, funded by Takeda Pharmaceutical Company and Eli Lilly and Company, summarizes that in patients with type-2 diabetes who are at high cardiovascular risk, pioglitazone improves cardiovascular outcome, and reduces the need to add insulin to glucose-lowering regimens compared with placebo.