Diabetes Medication May Slow Thickening of Artery Walls

A medication that is being prescribed to patients with diabetes appears to not only increase their body’s sensitivity to insulin, but also slow the thickening of their artery walls. A study posted online by JAMA confirms these results and will be presented at the American Heart Association Scientific Session.

It has already been proven that people with diabetes suffer from an increased risk of heart attack Controlling cholesterol (LDL) and blood pressure has been shown to lower some of this excess risk. “However, even with optimal control of these potent cardiovascular risk factors, incremental risk for cardiovascular events remains high compared with individuals without diabetes,” the authors say. “New approaches are, therefore, needed to further reduce cardiovascular risk in patients with diabetes.”

Theodore Mazzone, M.D., of the University of Illinois at Chicago College of Medicine, and his colleagues studied a drug called pioglitazone to see if it may help to reduce the excess risk of heart attack in patients with diabetes. The studied included 462 adults with type 2 diabetes in the Chicago area from 2003 to 2006. The average age of the group was 60 years and included 289 men and 173 women. These participants were randomly assigned to take either 15 to 45 milligrams of pioglitazone or 1 to 4 milligrams of glimepiride, another medication with the same effects but through different mechanisms. At the beginning of the study, an ultrasound was used to measure the thickness of the carotid arteries. A measure of glucose control, blood pressure, and blood cholesterol levels were also monitored throughout the study.

In total, 158 patients using pioglitazone and 165 patients using glimepiride completed the entire 72 week trial. At the beginning of the study, the two groups had comparable artery wall thickness. At the end of the study, the glimeperide groups average artery wall thickness increased by .012 millimeters while the pioglitazone groups average dropped by .001. “A pre-specified subgroup analysis based on age, sex, systoloc blood pressure, duration of type 2 diabetes mellitus, body mass index, hbA1c value and statin use showed a uniform beneficial effect of the pioglitazone treatment,” the authors write.

Over the course of the study, blood pressure remained very similar between both groups. By week 48, however, the pioglitazone group was significantly lower than the glimeperide group. HDL, or “good” cholesterol increased in the pioglitazone group and remained higher throughout the remainder of the study. These measurements represent that pioglitazone can reduce artery wall thickness.

"Additional data will be needed to determine the clinical significance of these findings; specifically, whether a strategy of routine use of pioglitazone instead of glimepiride substantially reduces major cardiovascular events," they concluded.