Pioglitazone and Rosiglitazone Have Different Effects on Serum Lipoprotein Particle Concentrations and Sizes in Patients With Type 2 Diabetes and Dyslipidemia

Abstract

OBJECTIVE -Associated with insulin resistance in type 2 diabetes are increased serum triglycerides, decreased HDL cholesterol, and a predominance of large VLDL, small LDL, and small HDL particles. The comparative effects of thiazolidinedione insulin sensitizers on serum lipoprotein particle concentrations and sizes in type 2 diabetes are not known. We studied the effects of pioglitazone (PIO) and rosiglitazone (ROSI) treatments on serum lipoprotein particle concentrations and sizes in type 2 diabetic patients with dyslipidemia. RESEARCH DESIGN AND METHODS-This is a prospective, randomized, doubleblind, multicenter, parallel-group study. After a 4-week placebo washout period, patients randomized to PIO (n ϭ 369) were treated with 30 mg q.d. for 12 weeks followed by 45 mg q.d. for another 12 weeks, while patients randomized to ROSI (n ϭ 366) were treated with 4 mg q.d. followed by 4 mg b.i.d. for the same intervals. Lipoprotein subclass particle concentrations and sizes were determined by proton nuclear magnetic resonance spectroscopy at baseline and end point (PIO [n ϭ 333] and ROSI [n ϭ 325] patients).RESULTS -PIO treatment increased total VLDL particle concentration less than ROSI treatment and decreased VLDL particle size more than ROSI. PIO treatment reduced total LDL particle concentration, whereas ROSI treatment increased it. Both treatments increased LDL particle size, with PIO treatment having a greater effect. Whereas PIO treatment increased total HDL particle concentration and size, ROSI treatment decreased them; both increased HDL cholesterol levels.CONCLUSIONS -PIO and ROSI treatments have different effects on serum lipoprotein subclass particle concentrations and sizes in patients with type 2 diabetes and dyslipidemia.

Effect of lifestyle intervention plus rosiglitazone or placebo therapy on left ventricular mass assessed with cardiovascular magnetic resonance in the metabolic syndrome

“…The finding that rosiglitazone increases HDL cholesterol is in accordance with previous clinical trials evaluating the effect of rosiglitazone on lipid profile in patients with type 2 diabetes, in which HDL cholesterol levels increased approximately 10 percent [29-31]. These studies also found an adverse effect on low-density lipoprotein (LDL) cholesterol levels after rosiglitazone therapy.…”

Effect of pioglitazone on various parameters of insulin resistance including lipoprotein subclass according to particle size by a gel-permeation high-performance liquid chromatography in newly diagnosed patients with type 2 diabetes

“…However, serum levels of conventional lipids and/or lipoproteins remained unchanged. This finding essentially agrees with the report of Deeg et al [21] who used proton nuclear magnetic resonance analysis to show pioglitazone treatment, but not rogiglitazone, caused a significant decrease in both large VLDL and small LDL. In addition, we demonstrated that the changes in large VLDL levels associated with pioglitazone therapy correlated positively with changes in HbA1c, HOMA-IR, very small LDL and emLDL, and correlated negatively with change in adiponectin.…”

Small dense low-density lipoprotein particles: priority as a treatment target in Type 2 diabetes?

“…During 24 weeks of treatment, total LDL particle concentration was reduced in the pioglitazone group, but increased in the rosiglitazone group. Both treatments were able to increase LDL particle size, but with pioglitazone having a greater effect [96]. We could confirm these findings in an own study [97].…”