Endocrine Abstracts

Risk of cardiovascular disease is higher for patients with diabetes and dyslipidemia. Known risk factors include elevated triglycerides (TG), total cholesterol (TC), LDL, and low HDL. The log(TG: HDL), known as Atherogenic Index of Plasma (AIP), is inversely correlated with LDL particle size (r=-0.78) and provides another marker of coronary heart disease (CHD) risk. Low-risk CHD cohorts have negative AIP values; high-risk cohorts have positive values. Patients with type 2 diabetes (T2D), have higher AIP values compared with matched controls.

Objective: compare the impact of pioglitazone (PIO) and rosiglitazone (ROSI) on lipids and glycemic control in patients with T2D.

A retrospective review of medical records was conducted in 605 practices across the US. Charts of patients >=18 years of age with T2D were identified, randomized to reduce selection bias, and reviewed for inclusion/exclusion criteria (eg, uninterrupted daily treatment with PIO [30mg/d to 45mg/d] or ROSI [4mg/d to 8 mg/d] for >=12 weeks; no change in concomitant antihyperlipidemic medication) that control for confounding independent variables. Data from charts of qualified patients were culled and analyzed.

1,115 (PIO, n=525; ROSI, n=590) patients met inclusion/exclusion criteria. Patient demographics, including comorbidities, baseline HbA_1c, and pre-treatment blood lipid concentrations, were similar between treatment groups, except for pre-treatment HDL (PIO: 1.12 mmol/L, ROSI: 1.19 mmol/L; P=0.024). Mean change in TG (PIO: -0.62 mmol\/L, ROSI: -0.15 mmol\/L; P<0.001), TC (PIO: -0.22 mmol\/L, ROSI: +0.12 mmol\/L; P<0.001), HDL (PIO: +0.07 mmol\/L, ROSI: -0.003 mmol/L; P=0.064), and LDL (PIO: -0.13 mmol\/L, ROSI: +0.09 mmol\/L; P<0.001) were significantly greater and more beneficial for patients receiving PIO vs. ROSI. Mean change in AIP was better (P<0.001) among patients receiving PIO (-0.11) vs. ROSI (-0.03); glycemic control was similar.

PIO had greater beneficial impact on CHD risk factors (blood lipids and AIP) than ROSI, suggesting greater potential for cardiovascular disease risk reduction.

Boyle et al. 2002 Clin. Ther. 24 (In Press)