Effect of Pioglitazone in Preventing In-Stent Restenosis after Percutaneous Coronary Intervention in Patients with Type 2 Diabetes: A Meta-Analysis

Zhao, Shijie; Zhong, Zhaoshuang; Qi, Guoxian; Shi, Liye; Ling, Chen; Tian, Wen

doi:10.1371/journal.pone.0155273

Cited by 10 publications

(13 citation statements)

References 45 publications

(54 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…All these factors could interfere with the effect of pioglitazone for reduced MACCEs. On the other hand, pioglitazone's effect in lipid lowering via regulation of adipogenesis remained intact in ESRD patients [16,29], which could be supported by our observation that patients with underlying dyslipidemia benefit more from pioglitazone rather than DPP4-inhibitors.…”

Section: Discussionmentioning

confidence: 53%

“…Moreover, numerous studies among PPAR-γ showed its potential role in the treatment of cardiovascular disease [16,[22][23][24]. These were compatible with the outcome trial and observation study of pioglitazone [21,[25][26][27][28][29][30][31]. However, it is of some concern in the population with advanced renal impairment, due to the side effect of fluid overload and the risk of bone loss and congestive heart failure [9,18,21,31,32].…”

Section: Introductionmentioning

confidence: 62%

“…Pioglitazone is a full PPAR-γ agonist, affecting multi-system with the potential to promote health or reduce lethal consequences in patients with DM [16][17][18]25,27,29,40]. The advantages and mechanism of PPAR-γ agonist includes inhibition of cytokine production by macrophages, reduction of oxidative stress, improving insulin resistance, control dyslipidemia due to the regulation of adipogenesis, and lowering blood pressure via vasodilation [22,24].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Pioglitazone Is Associated with Lower Major Adverse Cardiovascular and Cerebrovascular Events than DPP4-Inhibitors in Diabetic Patients with End-Stage Renal Disease: A Taiwan Nationwide Cohort Study, 2006–2016

Lin

Yang

Yen

et al. 2020

JCM

View full text Add to dashboard Cite

While pioglitazone reduces insulin resistance and hepatic gluconeogenesis effectively in patients with type 2 diabetes mellitus (T2DM), these benefits remained controversial in patients with end stage renal disease (ESRD). We compared major adverse cardiac cerebrovascular events (MACCEs) and mortality (overall, infection-related, and MACCE-related) of pioglitazone to that of dipeptidyl peptidase 4 inhibitors (DPP4-inhibitors) in patients with T2DM and ESRD. From Taiwan’s national health insurance research database (NHIRD), 647 pioglitazone users and 6080 DPP4-inhibitors users between 1 April 2006 and 31 December 2016 were followed from the 91th date after the ESRD certification until the study outcomes, independently; withdraw from the NHI program, death, or 31 December 2017, whichever came first. After weighting, risks of MACCEs (10.48% vs. 12.62% per person-years, hazard ratio (HR): 0.85, 95% (CI): 0.729–0.985) and all-cause mortality (12.86% vs. 13.22% per person-years, (HR): 0.88, 95% (CI): 0.771–0.995) are significantly lower in pioglitazone group. Subgroup analysis found lower MACCEs risk in the pioglitazone users without insulin therapy (6.44% vs. 10.04% (HR): 0.59, 95% (CI): 0.42–0.82) and lower MACCEs related death (2.76% vs. 3.84% (HR): 0.61, 95% (CI): 0.40–0.95) in the pioglitazone group with dyslipidemia, when comparing with DPP4-inhibitors users. Pioglitazone is associated with lower all-cause mortality and MACCEs in diabetic patients with ESRD, compared to DPP4-inhibitors. These benefits were even more significant in the non-insulin users and patients with dyslipidemia.

show abstract

Section: Discussionmentioning

confidence: 53%

Section: Introductionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Pioglitazone Is Associated with Lower Major Adverse Cardiovascular and Cerebrovascular Events than DPP4-Inhibitors in Diabetic Patients with End-Stage Renal Disease: A Taiwan Nationwide Cohort Study, 2006–2016

Lin

Yang

Yen

et al. 2020

JCM

View full text Add to dashboard Cite

show abstract

“…Metformin, a biguanide, has shown to reduce infection rates 8 . Sulfonylureas may increase the risk of death following coronary angioplasty, whereas thiazolidinediones seem to be have no effect 9,10 …”

Section: Introductionmentioning

confidence: 99%

Effects of antidiabetic medications on cardiovascular outcomes

et al. 2020

View full text Add to dashboard Cite

Objectives: Hyperglycemia is associated with an increased risk of adverse cardiovascular outcomes, such as heart failure, coronary heart disease, stroke, and in-hospital mortality. For those receiving cardiac surgery, up to half develop hyperglycemia while 30% have a diagnosis of diabetes, which is defined by chronic hyperglycemia. Due to a prothrombic state and endovascular damage, patients with diabetes have a twofold increased risk of cardiovascular events. Methods: Electronic literature search was done to identify articles that have discussed antidiabetic medications and how it is impacting the glycemia status as well as cardiovascular outcomes. No limits were placed on timing of the publication or type of the article. Key words and MeSH terms were used to conduct the search and the results are summarized in a narrative manner within each relevant section. Results: Antidiabetic medications play a key role in lowering blood glucose levels to reduce adverse cardiovascular outcomes. However, it is a challenge to assess their cardiovascular safety due to confounding factors, such as age, obesity, smoking, hyperlipidemia, and high blood pressure. Further research in this field is required to understand this correlation closely. Conclusion: Optimizing blood glucose level during the perioperative period with correct medication and dose have a significant role in reducing morbidities. Measures should be taken to provide a safe blood glucose level for optimum outcomes.

show abstract

“…Rosiglitazone and pioglitazone currently are commercially available. Previous meta-analysis have demonstrated benefits of both TZDs and pioglitazone in prevention of ISR and target lesion revascularization (TLR) 8 – 12 . Few of these analyses are based on RCT data; the results of these studies are also inconsistent.…”

Section: Introductionmentioning

confidence: 99%

Different Effects of Thiazolidinediones on In-Stent Restenosis and Target Lesion Revascularization after PCI: A Meta-Analysis of Randomized Controlled Trials

Zhou

Chen

Zhu

et al. 2017

Sci Rep

View full text Add to dashboard Cite

In-stent restenosis (ISR) remains the leading problem encountered after percutaneous coronary intervention (PCI). Thiazolidinediones (TZDs) has been shown to be associated with reduced ISR and target lesion revascularization (TLR); however, the results are inconsistent, especially between rosiglitazone and pioglitazone. In this study, fourteen RCTs with a total of 1350 patients were finally included through a systematical literature search of Embase, Pubmed, the Cochrane Library, and ClinicalTrials.gov from inception to January 31, 2017. The follow-up duration of the included trials ranged from 6 months to 18 months. The results demonstrated that TZDs treatment is associated with significantly reduced risk of TLR (RR:0.45, 95%CI 0.30 to 0.67 for pioglitazone, RR:0.68, 95%CI 0.46 to 1.00 for rosiglitazone). Pioglitazone is associated with significantly reduced risks of ISR (RR:0.47, 95%CI 0.27 to 0.81), major adverse cardiac events (MACE) (RR:0.44, 95%CI 0.30 to 0.64) and neointimal area (SMD: −0.585, 95%CI −0.910 to −0.261). No significant relationship was observed between rosiglitazone and ISR (RR:0.91, 95%CI 0.39 to 2.12), MACE (RR:0.73, 95%CI 0.53 to 1.00) and neointimal area (SMD: −0.164, 95%CI −1.146 to 0.818). This meta-analysis demonstrated that TZDs treatment is associated with significant reduction in ISR, TLR and MACE for patients after PCI. Pioglitazone treatment seems to have more beneficial effects than rosiglitazone and no significantly increased cardiovascular risk was detected for both agents.

show abstract

Effect of Pioglitazone in Preventing In-Stent Restenosis after Percutaneous Coronary Intervention in Patients with Type 2 Diabetes: A Meta-Analysis

Cited by 10 publications

References 45 publications

Pioglitazone Is Associated with Lower Major Adverse Cardiovascular and Cerebrovascular Events than DPP4-Inhibitors in Diabetic Patients with End-Stage Renal Disease: A Taiwan Nationwide Cohort Study, 2006–2016

Pioglitazone Is Associated with Lower Major Adverse Cardiovascular and Cerebrovascular Events than DPP4-Inhibitors in Diabetic Patients with End-Stage Renal Disease: A Taiwan Nationwide Cohort Study, 2006–2016

Effects of antidiabetic medications on cardiovascular outcomes

Different Effects of Thiazolidinediones on In-Stent Restenosis and Target Lesion Revascularization after PCI: A Meta-Analysis of Randomized Controlled Trials

Contact Info

Product

Resources

About