Department of Medicine, Heart Center, University of Cologne, Cologne, Germany.
QJM. 2010 Apr;103(4):213-28. doi: 10.1093/qjmed/hcp168. Epub 2009 Dec 2.
Pioglitazone has diverse multiple effects on metabolic and inflammatory processes that have the potential to influence cardiovascular disease pathophysiology at various points in the disease process, including atherogenesis, plaque inflammation, plaque rupture, haemostatic disturbances and microangiopathy.
Linking the many direct and indirect effects on the vasculature to the reduction in key macrovascular outcomes reported with pioglitazone in patients with type 2 diabetes presents a considerable challenge. However, recent large-scale clinical cardiovascular imaging studies are beginning to provide some mechanistic insights, including a potentially important role for improvements in high-density lipoprotein cholesterol with pioglitazone. In addition to a role in prevention, animal studies also suggest that pioglitazone may minimize damage and improve recovery during and after ischaemic cardio- and cerebrovascular events.
In this review, we consider potential cardiovascular protective mechanisms of pioglitazone by linking preclinical data and clinical cardiovascular outcomes guided by insights from recent imaging studies.
Pioglitazone may influence CVD pathophysiology at multiple points in the disease process, including atherogenesis, plaque inflammation, plaque rupture and haemostatic disturbances (i.e. thrombus/embolism formation), as well as microangiopathy.
吡格列酮对代谢和炎症过程具有多种多重作用，有可能在疾病过程的各个点影响心血管疾病的病理生理学，包括动脉粥样硬化形成、斑块炎症、斑块破裂、止血紊乱和微血管病变。
将对血管的许多直接和间接影响与在 2 型糖尿病患者中报告的吡格列酮对主要大血管结局的降低联系起来，这是一个相当大的挑战。然而，最近的大规模临床心血管成像研究开始提供一些机制上的见解，包括吡格列酮改善高密度脂蛋白胆固醇可能具有重要作用。除了在预防中的作用外，动物研究还表明，吡格列酮可能在缺血性心脏和脑血管事件期间和之后最小化损伤并改善恢复。
在这篇综述中，我们通过将临床前数据与最近的影像学研究提供的见解联系起来，考虑吡格列酮的潜在心血管保护机制。
吡格列酮可能在疾病过程的多个点影响心血管疾病的病理生理学，包括动脉粥样硬化形成、斑块炎症、斑块破裂和止血紊乱（即血栓/栓塞形成）以及微血管病变。
