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- September 9, 2010 |
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"CARDIOVASCULAR EFFECTS OF TZD'S: A CARDIOLOGY PERSPECTIVE"Dr. John Amerena (biography)
English - 2007-11-10 - 34 minutes
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Summary :
In this presentation Dr. Amerena presents a clinical perspective on the cardiovascular-related effects of the insulin-sensitising thiazolidinedione drugs (TZDs/glitazones).
In June of this year, a meta-analysis was published by Nissen and Wolski in The New England Journal of Medicine, entitled “Effect of Rosiglitazone on the Risk of Myocardial Infarction and Death from Cardiovascular Causes.” The paper has since come under criticism due to a lack of extensive review or enough focus on the flaws of the study.
The glitazones are recognised to reduce the levels of atherosclerotic biomarkers while increasing adiponectin, to have a modest blood-pressure-lowering effect, and to improve endothelial function. Theoretically they should also be able to reduce plaque vulnerability, as they have been shown to decrease levels of MMP-9 in patients with diabetes and coronary artery disease (1).
The effects on plasma lipids have been found to differ between pioglitazone and rosiglitazone. In the study by Goldberg et al., rosglitazone and pioglitazone were found to increase and decrease triglycerides, respectively, and both drugs were found to raise LDL cholesterol (LDL-C), with pioglitazone doing so to a lesser extent (2). Most patients on a TZD will however also be taking a statin, which could be titrated to achieve a target LDL-C level of <2.0 mmol/L, for example.
Heart failure is known to be increased in patients with diabetes, and diastolic dysfunction in diabetes occurs due to a variety of mechanisms. There has been an increased risk of development of symptomatic heart failure found to be associated with pioglitazone and rosiglitazone use (3), which is thought to be related to fluid retention. By stopping the medication, fluid retention diminishes.
Dr. Amerena discusses these issues in more detail, from a cardiology perspective.
Copyright © 2007 E-MedHosting.com Inc.
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Feedback on the meta-analysis published by Nissen and Wolski (NEJM 2007)
- Effects of glitazones on atherosclerotic biomarkers and plasma lipids
- Risk of heart failure and TZDs: useful information for clinicians
Bibliographic references :
1. Nikolaus Marx; Johannes Froehlich; Laila Siam; Jochen Ittner; Gerhard Wierse; Arnold Schmidt; Hubert Scharnagl; Vinzenz Hombach; Wolfgang Koenig Antidiabetic PPAR{gamma}-Activator Rosiglitazone Reduces MMP-9 Serum Levels in Type 2 Diabetic Patients With Coronary Artery Disease Arteriosclerosis, Thrombosis, and Vascular Biology. 2003.
2. Goldberg RB, Kendall DM, Deeg MA, Buse JB, Zagar AJ, Pinaire JA, Tan MH, Khan MA, Perez AT, Jacober SJ; GLAI Study Investigators.A Comparison of Lipid and Glycemic Effects of Pioglitazone and Rosiglitazone in Patients With Type 2 Diabetes and Dyslipidemia Diabetes Care 28:1547-1554, 2005.
3. Singh S, Loke YK, Furberg CD.Thiazolidinediones and Heart Failure: A teleo-analysis Diabetes Care Publish Ahead of Print published online ahead of print May 29, 2007.
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