Heart Disease Prevention -- What Place for the Glitazones?
In this article Professor Michael Kirby analyses the first major outcome study with glitazones, the PROactive study, and looks at the role for glitazones in the light of its findings.
This paper considers the role for glitazones in the treatment of type 2 diabetes following publication of the PRO active study, the first major outcome study with this class of agents. The macrovascular benefits of glitazones are discussed. Recent guidance for glitazone prescribing from the Association of British Clinical Diabetologists is also given.
The long-awaited publication of the PROactive (PROspective pioglitAzone Clinical Trial in macroVascular Events) study has once again focused our clinical attention on glitazones.
This 5,000-patient, prospective, randomised trial investigated whether the addition of pioglitazone could reduce macrovascular morbidity and mortality in type 2 diabetes patients who were receiving optimal pharmacotherapy, and had already suffered a cardiovascular event.
The key findings of the study were that adding pioglitazone to optimal therapy in these high-risk patients:
In this article Professor Michael Kirby analyses the first major outcome study with glitazones, the PROactive study, and looks at the role for glitazones in the light of its findings.
Abstract and Introduction
Abstract
This paper considers the role for glitazones in the treatment of type 2 diabetes following publication of the PRO active study, the first major outcome study with this class of agents. The macrovascular benefits of glitazones are discussed. Recent guidance for glitazone prescribing from the Association of British Clinical Diabetologists is also given.
Introduction
The long-awaited publication of the PROactive (PROspective pioglitAzone Clinical Trial in macroVascular Events) study has once again focused our clinical attention on glitazones.
This 5,000-patient, prospective, randomised trial investigated whether the addition of pioglitazone could reduce macrovascular morbidity and mortality in type 2 diabetes patients who were receiving optimal pharmacotherapy, and had already suffered a cardiovascular event.
The key findings of the study were that adding pioglitazone to optimal therapy in these high-risk patients:
evokes a significant reduction in the number of deaths, heart attacks and strokes (16% reduction in this composite end point; p=0.027)
achieves significantly better glycaemic control (HbA1C absolute change from baseline: -0.8% vs. -0.3%, p<0.0001)
significantly reduces dyslipidaemia (percentage change in high density lipoprotein [HDL]/low density lipoprotein [LDL]ratio: -9.5% vs. - 4.2%, p<0.0001; percentage change in triglycerides: -11.4% vs. - 1.8%, p<0.0001)
significantly delays the progression to insulin (53% reduced risk of permanent insulin use, p<0.001).