There is increasing evidence that thiazolidinediones (TZDs), antidiabetic compounds that are synthetic ligands for the peroxisome proliferator-activated receptor ␥ (PPAR␥), have cardiovascular effects through as yet poorly defined mechanisms. We tested the effect of two TZD class drugs, rosiglitazone and pioglitazone, on human aortic smooth muscle cell (SMC) expression of insulin-like growth factor-1 receptor (IGF-1R). Both TZDs dose dependently up-regulated IGF-1R protein levels (rosiglitazone, 10 mol/liter, 67% increase, n ؍ 4, p < 0.01; pioglitazone, 10 mol/liter, 41% increase, n ؍ 4, p < 0.01) and increased IGF-1R signaling activity (36% increase in Akt phosphorylation). However, the endogenous PPAR␥ ligand, 15-deoxy-⌬ 12,14 -prostaglandin J 2 , dose dependently reduced IGF-1R (10 mol/liter, 80% decrease, n ؍ 4, p < 0.01), and overexpression of PPAR␥ using an adenovirus likewise reduced IGF-1R (50% decrease versus SMC infected with control adenovirus), suggesting a PPAR␥-independent action of TZDs. Thiazolidinediones (TZDs) 2 are insulin-sensitizing drugs used in patients with type 2 diabetes mellitus. Over the past decade, it has been suggested that TZDs could have anti-atherosclerotic effects (1-4), although human studies thus far have not been conclusive with regard to potential benefits (5-7), and one meta-analysis has suggested that rosiglitazone increased the risk of myocardial infarction (8). PPAR␥ agonists including TZDs have been found to reduce atherosclerosis in rodent models such as LDL receptor-null mice and apolipoprotein E-deficient mice (9 -12). TZDs inhibit proliferation and migration of cultured vascular smooth muscle cells (SMCs), which may contribute to their potential beneficial effect on atherogenesis (13-15).Insulin-like growth factor-1 (IGF-1), a growth factor found in the circulation and also produced locally in multiple tissues including the vasculature, has pleiotropic effects on vascular cells including SMCs (reviewed in Refs. 16 and 17). For instance, IGF-1 is a mitogen for vascular SMCs and could be involved in the restenotic process after mechanical vascular injury (18,19). Contrary to its mitogenic effect, it has also been reported that IGF-1 signaling is important for maintenance of the differentiated SMC phenotype (20, 21). IGF-1 is a potent survival factor for vascular SMCs. Thus, we have previously reported that oxidized low density lipoprotein (oxLDL), a highly pro-atherogenic lipoprotein present in circulation and in atherosclerotic plaques (22, 23), down-regulates IGF-1 in vascular cells (16,24), and overexpression of IGF-1 receptor (IGF-1R) prevents oxLDL-induced apoptosis of vascular cells (25). Intriguingly, IGF-1 and IGF-1R expression are reduced in areas of advanced human plaque staining positive for oxLDL (26,27), indicating a potential association between reduced IGF-1 function and the acellular phenotype of advanced plaques. Collectively, our studies suggest that IGF-1 serves as a survival factor for vascular SMCs, preventing SMC loss from atherosclerotic ...