Lowering the triglyceride/high-density lipoprotein cholesterol ratio is associated with the beneficial impact of pioglitazone on progression of coronary atherosclerosis in diabetic patients: Insights from the periscope (pioglitazone effect on regression of intravascular sonographic coronary obstruction prospective evaluation) study

Stephen J. Nicholls, E. Murat Tuzcu, Kathy Wolski, Ozgur Bayturan, Andrea Lavoie, Kiyoko Uno, Stuart Kupfer, Alfonso Perez, Richard Nesto, Steven E. Nissen

Research output: Contribution to journalArticle

83 Citations (Scopus)

Abstract

Objectives The purpose of this study was to determine the factors associated with the favorable effect of pioglitazone on atheroma progression. Background Diabetes mellitus is associated with accelerated coronary atheroma progression. Pioglitazone slowed progression compared with glimepiride in this population. Methods In all, 360 diabetic patients with coronary artery disease were treated with pioglitazone or glimepiride for 18 months in the PERISCOPE (Pioglitazone Effect on Regression of Intravascular Sonographic Coronary Obstruction Prospective Evaluation) study. Coronary atheroma progression was evaluated by serial intravascular ultrasound. The relationship between changes in biochemical parameters, percent atheroma volume, and total atheroma volume was investigated. Results Pioglitazone-treated patients demonstrated greater increases in high-density lipoprotein cholesterol (HDL-C) and reductions in glycated hemoglobin, triglycerides, and C-reactive protein. Significant correlations were observed between changes in percent atheroma volume and triglycerides (r = 0.15, p = 0.04), triglyceride/HDL-C ratio (r = 0.16, p = 0.03), and glycated hemoglobin (r = 0.16, p = 0.03) with pioglitazone, and changes in low-density lipoprotein cholesterol (r = -0.15, p = 0.05), apolipoprotein B (r = -0.16, p = 0.04), and apolipoprotein A-I (r = -0.20, p = 0.01) with glimepiride. Substantial atheroma regression, compared to progression, was associated with greater relative increases in HDL-C (14.2% vs. 7.8%, p = 0.04), relative decreases in triglycerides (-13.3% vs. -1.9%, p = 0.045), triglyceride/HDL-C ratio (-22.5 vs. -9.9%, p = 0.05), and decrease in glycated hemoglobin (-0.6% vs. -0.3%, p = 0.01). Multivariable analysis revealed that pioglitazone-induced effects on triglyceride/HDL-C were associated with changes in percent atheroma volume (p = 0.03) and total atheroma volume (p = 0.02). Conclusions Favorable effects of pioglitazone on the triglyceride/HDL-C ratio correlated with delayed atheroma progression in diabetic patients. This finding highlights the potential importance of targeting atherogenic dyslipidemia in diabetic patients with coronary artery disease.

LanguageEnglish
Pages153-159
Number of pages7
JournalJournal of the American College of Cardiology
Volume57
Issue number2
DOIs
Publication statusPublished - 11 Jan 2011

Keywords

  • atherosclerosis
  • diabetes
  • intravascular ultrasonography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{f78c67d2113d4d1988b06d13cf370e14,
title = "Lowering the triglyceride/high-density lipoprotein cholesterol ratio is associated with the beneficial impact of pioglitazone on progression of coronary atherosclerosis in diabetic patients: Insights from the periscope (pioglitazone effect on regression of intravascular sonographic coronary obstruction prospective evaluation) study",
abstract = "Objectives The purpose of this study was to determine the factors associated with the favorable effect of pioglitazone on atheroma progression. Background Diabetes mellitus is associated with accelerated coronary atheroma progression. Pioglitazone slowed progression compared with glimepiride in this population. Methods In all, 360 diabetic patients with coronary artery disease were treated with pioglitazone or glimepiride for 18 months in the PERISCOPE (Pioglitazone Effect on Regression of Intravascular Sonographic Coronary Obstruction Prospective Evaluation) study. Coronary atheroma progression was evaluated by serial intravascular ultrasound. The relationship between changes in biochemical parameters, percent atheroma volume, and total atheroma volume was investigated. Results Pioglitazone-treated patients demonstrated greater increases in high-density lipoprotein cholesterol (HDL-C) and reductions in glycated hemoglobin, triglycerides, and C-reactive protein. Significant correlations were observed between changes in percent atheroma volume and triglycerides (r = 0.15, p = 0.04), triglyceride/HDL-C ratio (r = 0.16, p = 0.03), and glycated hemoglobin (r = 0.16, p = 0.03) with pioglitazone, and changes in low-density lipoprotein cholesterol (r = -0.15, p = 0.05), apolipoprotein B (r = -0.16, p = 0.04), and apolipoprotein A-I (r = -0.20, p = 0.01) with glimepiride. Substantial atheroma regression, compared to progression, was associated with greater relative increases in HDL-C (14.2{\%} vs. 7.8{\%}, p = 0.04), relative decreases in triglycerides (-13.3{\%} vs. -1.9{\%}, p = 0.045), triglyceride/HDL-C ratio (-22.5 vs. -9.9{\%}, p = 0.05), and decrease in glycated hemoglobin (-0.6{\%} vs. -0.3{\%}, p = 0.01). Multivariable analysis revealed that pioglitazone-induced effects on triglyceride/HDL-C were associated with changes in percent atheroma volume (p = 0.03) and total atheroma volume (p = 0.02). Conclusions Favorable effects of pioglitazone on the triglyceride/HDL-C ratio correlated with delayed atheroma progression in diabetic patients. This finding highlights the potential importance of targeting atherogenic dyslipidemia in diabetic patients with coronary artery disease.",
keywords = "atherosclerosis, diabetes, intravascular ultrasonography",
author = "Nicholls, {Stephen J.} and Tuzcu, {E. Murat} and Kathy Wolski and Ozgur Bayturan and Andrea Lavoie and Kiyoko Uno and Stuart Kupfer and Alfonso Perez and Richard Nesto and Nissen, {Steven E.}",
year = "2011",
month = "1",
day = "11",
doi = "10.1016/j.jacc.2010.06.055",
language = "English",
volume = "57",
pages = "153--159",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "2",

}

Lowering the triglyceride/high-density lipoprotein cholesterol ratio is associated with the beneficial impact of pioglitazone on progression of coronary atherosclerosis in diabetic patients : Insights from the periscope (pioglitazone effect on regression of intravascular sonographic coronary obstruction prospective evaluation) study. / Nicholls, Stephen J.; Tuzcu, E. Murat; Wolski, Kathy; Bayturan, Ozgur; Lavoie, Andrea; Uno, Kiyoko; Kupfer, Stuart; Perez, Alfonso; Nesto, Richard; Nissen, Steven E.

In: Journal of the American College of Cardiology, Vol. 57, No. 2, 11.01.2011, p. 153-159.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Lowering the triglyceride/high-density lipoprotein cholesterol ratio is associated with the beneficial impact of pioglitazone on progression of coronary atherosclerosis in diabetic patients

T2 - Journal of the American College of Cardiology

AU - Nicholls, Stephen J.

AU - Tuzcu, E. Murat

AU - Wolski, Kathy

AU - Bayturan, Ozgur

AU - Lavoie, Andrea

AU - Uno, Kiyoko

AU - Kupfer, Stuart

AU - Perez, Alfonso

AU - Nesto, Richard

AU - Nissen, Steven E.

PY - 2011/1/11

Y1 - 2011/1/11

N2 - Objectives The purpose of this study was to determine the factors associated with the favorable effect of pioglitazone on atheroma progression. Background Diabetes mellitus is associated with accelerated coronary atheroma progression. Pioglitazone slowed progression compared with glimepiride in this population. Methods In all, 360 diabetic patients with coronary artery disease were treated with pioglitazone or glimepiride for 18 months in the PERISCOPE (Pioglitazone Effect on Regression of Intravascular Sonographic Coronary Obstruction Prospective Evaluation) study. Coronary atheroma progression was evaluated by serial intravascular ultrasound. The relationship between changes in biochemical parameters, percent atheroma volume, and total atheroma volume was investigated. Results Pioglitazone-treated patients demonstrated greater increases in high-density lipoprotein cholesterol (HDL-C) and reductions in glycated hemoglobin, triglycerides, and C-reactive protein. Significant correlations were observed between changes in percent atheroma volume and triglycerides (r = 0.15, p = 0.04), triglyceride/HDL-C ratio (r = 0.16, p = 0.03), and glycated hemoglobin (r = 0.16, p = 0.03) with pioglitazone, and changes in low-density lipoprotein cholesterol (r = -0.15, p = 0.05), apolipoprotein B (r = -0.16, p = 0.04), and apolipoprotein A-I (r = -0.20, p = 0.01) with glimepiride. Substantial atheroma regression, compared to progression, was associated with greater relative increases in HDL-C (14.2% vs. 7.8%, p = 0.04), relative decreases in triglycerides (-13.3% vs. -1.9%, p = 0.045), triglyceride/HDL-C ratio (-22.5 vs. -9.9%, p = 0.05), and decrease in glycated hemoglobin (-0.6% vs. -0.3%, p = 0.01). Multivariable analysis revealed that pioglitazone-induced effects on triglyceride/HDL-C were associated with changes in percent atheroma volume (p = 0.03) and total atheroma volume (p = 0.02). Conclusions Favorable effects of pioglitazone on the triglyceride/HDL-C ratio correlated with delayed atheroma progression in diabetic patients. This finding highlights the potential importance of targeting atherogenic dyslipidemia in diabetic patients with coronary artery disease.

AB - Objectives The purpose of this study was to determine the factors associated with the favorable effect of pioglitazone on atheroma progression. Background Diabetes mellitus is associated with accelerated coronary atheroma progression. Pioglitazone slowed progression compared with glimepiride in this population. Methods In all, 360 diabetic patients with coronary artery disease were treated with pioglitazone or glimepiride for 18 months in the PERISCOPE (Pioglitazone Effect on Regression of Intravascular Sonographic Coronary Obstruction Prospective Evaluation) study. Coronary atheroma progression was evaluated by serial intravascular ultrasound. The relationship between changes in biochemical parameters, percent atheroma volume, and total atheroma volume was investigated. Results Pioglitazone-treated patients demonstrated greater increases in high-density lipoprotein cholesterol (HDL-C) and reductions in glycated hemoglobin, triglycerides, and C-reactive protein. Significant correlations were observed between changes in percent atheroma volume and triglycerides (r = 0.15, p = 0.04), triglyceride/HDL-C ratio (r = 0.16, p = 0.03), and glycated hemoglobin (r = 0.16, p = 0.03) with pioglitazone, and changes in low-density lipoprotein cholesterol (r = -0.15, p = 0.05), apolipoprotein B (r = -0.16, p = 0.04), and apolipoprotein A-I (r = -0.20, p = 0.01) with glimepiride. Substantial atheroma regression, compared to progression, was associated with greater relative increases in HDL-C (14.2% vs. 7.8%, p = 0.04), relative decreases in triglycerides (-13.3% vs. -1.9%, p = 0.045), triglyceride/HDL-C ratio (-22.5 vs. -9.9%, p = 0.05), and decrease in glycated hemoglobin (-0.6% vs. -0.3%, p = 0.01). Multivariable analysis revealed that pioglitazone-induced effects on triglyceride/HDL-C were associated with changes in percent atheroma volume (p = 0.03) and total atheroma volume (p = 0.02). Conclusions Favorable effects of pioglitazone on the triglyceride/HDL-C ratio correlated with delayed atheroma progression in diabetic patients. This finding highlights the potential importance of targeting atherogenic dyslipidemia in diabetic patients with coronary artery disease.

KW - atherosclerosis

KW - diabetes

KW - intravascular ultrasonography

UR - http://www.scopus.com/inward/record.url?scp=78650904244&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2010.06.055

DO - 10.1016/j.jacc.2010.06.055

M3 - Article

VL - 57

SP - 153

EP - 159

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 2

ER -