Impact of pioglitazone on coronary endothelial function in non-diabetic patients with coronary artery disease.

Author(s): Wohrle J, Marx N, Koenig W, Hombach V, Kestler HA, Hoher M, Nusser T

Affiliation(s): Department of Internal Medicine II, University of Ulm, Robert-Koch-Str. 8, 89081, Ulm, Germany, jochen.woehrle@uniklinik-ulm.de.

Publication date & source: 2008-04-24, Clin Res Cardiol., [Epub ahead of print]

Publication type:

OBJECTIVE: Pioglitazone has been shown to exert multiple antiatherosclerotic actions independent from its glycemic effects. We studied the hypothesis that pioglitazone improves coronary endothelial dysfunction in non-diabetic patients with coronary artery disease (CAD) in a randomized, placebo-controlled, double-blind trial. METHODS: Fifty non-diabetic patients with CAD were randomized to 6 months treatment with pioglitazone 30 mg daily or placebo. Coronary endothelial function was tested at baseline and after 6 months with intracoronary infusion of adenosine, acetylcholine (0.072; 0.72; 7.2, and 36 microg/min), glyceroltrinitrate, and cold pressor test (CPT). The primary endpoint was the mean effect of treatment compared with placebo on acetylcholine-induced coronary vascular response for all acetylcholine dosages, based on percent change in luminal area measured by quantitative coronary angiography. RESULTS: There was no difference in baseline coronary endothelial function. The primary endpoint was significantly different between the groups with a 1.8% +/- 2.0% increase in luminal area between baseline and follow-up with pioglitazone and a 7.6% +/- 2.4% decrease in the placebo group (P < 0.008). At follow-up, there was a trend for a difference in CPT (P = 0.057). No difference was observed regarding intracoronary glyceroltrinitrate or adenosine. CONCLUSIONS: Pioglitazone treatment in non-diabetic patients with CAD was associated with a significantly better coronary endothelial function compared to placebo.