Author + information
- Received May 24, 2013
- Revision received August 14, 2013
- Accepted September 13, 2013
- Published online November 1, 2013.
- Yoshikazu Nitta, MD∗,
- Nobuhiro Tahara, MD, PhD∗∗ (, )
- Atsuko Tahara, MD∗,
- Akihiro Honda, MD∗,
- Norihiro Kodama, MD∗,
- Minori Mizoguchi, MD, PhD∗,
- Hayato Kaida, MD, PhD†,
- Masatoshi Ishibashi, MD, PhD†,
- Naofumi Hayabuchi, MD, PhD†,
- Hisao Ikeda, MD, PhD∗,
- Sho-ichi Yamagishi, MD, PhD‡ and
- Tsutomu Imaizumi, MD, PhD∗
- ∗Department of Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Kurume, Japan
- †Department of Radiology, PET Center, Division of Nuclear Medicine, Kurume University School of Medicine, Kurume, Japan
- ‡Department of Pathophysiology and Therapeutics of Diabetic Vascular Complications, Kurume University School of Medicine, Kurume, Japan
- ↵∗Reprint requests and correspondence:
Dr. Nobuhiro Tahara, Department of Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan.
Objectives The aim of this study was to compare the effect of pioglitazone with glimepiride on coronary arterial inflammation with serial 18F-fluorodeoxyglucose (FDG)–positron emission tomography (PET) combined with computed tomography (CT) angiography.
Background Recent studies have shown that FDG-PET combined with CT is a reliable tool to visualize and quantify vascular inflammation. Although pioglitazone significantly prevented the progression of coronary atherosclerosis and reduced the recurrence of myocardial infarction in patients with type 2 diabetes mellitus (DM), it remains unclear whether pioglitazone could attenuate coronary artery inflammation.
Methods Fifty atherosclerotic patients with impaired glucose tolerance or type 2 DM underwent determination of blood chemistries, anthropometric and inflammatory variables, and FDG-PET/CT angiography, and then were randomized to receive either pioglitazone or glimepiride for 16 weeks. Effects of the treatments on vascular inflammation of the left main trunk were evaluated by FDG-PET/CT angiography at baseline and end of the study. Vascular inflammation of the left main trunk was measured by blood-normalized standardized uptake value, known as a target-to-background ratio.
Results Three patients dropped out of the study during the assessment or treatment. Finally, 25 pioglitazone-treated patients and 22 glimepiride-treated patients (37 men; mean age: 68.1 ± 8.3 years; glycosylated hemoglobin: 6.72 ± 0.70%) completed the study. After 16-week treatments, fasting plasma glucose and glycosylated hemoglobin values were comparably reduced in both groups. Changes in target-to-background ratio values from baseline were significantly greater in the pioglitazone group than in the glimepiride group (–0.12 ± 0.06 vs. 0.09 ± 0.07, p = 0.032), as well as changes in high-sensitivity C-reactive protein (pioglitazone vs. glimepiride group: median: –0.24 [interquartile range (IQR): –1.58 to –0.04] mg/l vs. 0.08 [IQR: –0.07 to 0.79] mg/l, p = 0.031).
Conclusions Our study indicated that pioglitazone attenuated left main trunk inflammation in patients with impaired glucose tolerance or DM in a glucose-lowering independent manner, suggesting that pioglitazone may protect against cardiac events in patients with impaired glucose tolerance or DM by suppressing coronary inflammation. (Anti-Inflammatory Effects of Pioglitazone; NCT00722631)
- computed tomography angiography
- coronary artery disease
- 18F-fluorodeoxyglucose–positron emission tomography
- high-sensitivity C-reactive protein
- vascular inflammation
This study was supported in part by grants-in-aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology, Tokyo, Japan (to Drs. Tahara, Yamagishi, and Imaizumi). All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 24, 2013.
- Revision received August 14, 2013.
- Accepted September 13, 2013.
- American College of Cardiology Foundation