Pioglitazone Appears to Reverse Atherosclerosis in Diabetes

04/09/08 Treatment Options

The question about which glucose-lowering medication is most advantageous may answer as well as rebut conventional wisdom about type 2 diabetes.

The drug sold under the brand name Actos and as a component of ActoPLUSMet—along with other pharmaceuticals of the same class—has been associated, with initiating or increasing incidence of congestive heart failure. Researchers have begun looking for treatments that will counteract the risk of congestive heart failure. Cleveland Clinic researchers presented their data to the American College of Cardiology 2008 Scientific Sessions. They determined that pioglitazone will stop the progression of plaque in the vessels of this high risk, type 2 diabetes group, but not so with one of the more common anti-diabetic medication glimepiride sold as Amaryl.

Atherosclerosis is common among type 1 and type 2 diabetics. It causes the arteries to harden and become clogged, decreasing blood supply to the brain, heart, and other vital organs. The study, led by Dr. Stephen Nissen, lasted 18 months and was known as PERISCOPE. The participants were given one of the two drugs and their heart vessels were examined periodically with a special ultra sound technology called IVUS. At the end of the study, the glimepride group (Amaryl) had a significant increase in the plaque, while the pioglitazone, or Actos, patients has less plaque then they started with. The drug also impacted HDL and triglyceride levels.

This study of 543 patients has been discussed extensively in the cardiac community and there are more questions than answers. The results need be duplicated by further clinical evaluations to determine whether the data is valid or an aberration. It certainly doesn’t mean diabetics should demand an alteration to their current medication. We don’t know what other factors that may be impacted. Until we do, it is far more prudent to wait and observe than be rash.