OBJECTIVE -Thiazolidinediones (TZDs) (rosiglitazone and pioglitazone) are a class of antidiabetes agents that have a high affinity for peroxisome proliferator-activated receptor-␥. TZDs initiate a multitude of physiologic processes that may elicit benefits as systemic agents for the prevention of restenosis requiring revascularization following percutaneous coronary intervention (PCI). Numerous trials have evaluated the impact of TZDs on repeat target vessel revascularization (TVR) in patients following PCI; however, several limitations (small sample size, inconclusive results, and risk factor stratification) complicate definitive conclusions. A meta-analysis was performed to evaluate the impact of TZDs on repeat TVR following PCI.RESEARCH DESIGN AND METHODS -Included trials met the following criteria: 1) prospective, randomized controlled trials evaluating available TZDs versus standards of care; 2) well-described protocol; 3) minimum of 6 months of follow-up; and 4) data provided on repeat TVR. Data are presented as relative risks (RRs) with 95% CIs. R estenosis requiring revascularization is a significant limitation of percutaneous coronary intervention (PCI). Despite the advent of improved mechanics and drug-eluting stents, the cumulative restenosis rate remains 20 -30% in the general PCI population and approaches 40% among patients with diabetes (1-5). It is possible that an inhibitory effect on restenosis may result from a synergistic combination of local and systemic strategies aiming at different mechanisms for reducing pathological neointimal formation (6). Several attempts have been made to reduce instent restenosis rates via systemic pharmacological agents, but, to date, these results have been disappointing (7,8).
RESULTSPeroxisome proliferator-activated receptors (PPARs) are nuclear receptor isoforms (including PPAR-␣, PPAR-␥, and PPAR-␦) that play a critical role in many physiologic processes (9). Endogenous ligands are hypothesized to affect lipid regulation and metabolism, whereas more potent synthetic PPAR ligands, such as the fibrates and thiazolidinediones (TZDs), are effective in the treatment of dyslipidemia and diabetes (10).TZDs, commonly referred to as glitazones, are a class of antidiabetes agents that represent the first synthetic compounds identified as high-affinity selective PPAR-␥ agonists. Two glitazones, rosiglitazone (Avandia; GlaxoSmithKline) and pioglitazone (Actos; Takeda/ Lilly), are commercially available for the treatment of type 2 diabetes. The first approved TZD, troglitazone (Rezulin; Warner-Lambert), was withdrawn from the market in 2000 due to idiosyncratic hepatitis.TZDs activate PPAR-␥ receptors providing improved insulin sensitivity and glucose control. TZDs also demonstrate favorable effects in artherogenic dyslipidemia without dramatic changes in LDL concentrations (11). In addition to the benefit on glycemia and lipids, TZDs inhibit inflammatory cell responses, as well as inhibit proliferation of vascular smooth muscle cells (VSMCs), development of artherosclerot...