Pioglitazone: The forgotten, cost-effective cardioprotective drug for type 2 diabetes
Pioglitazone: The forgotten, cost-effective cardioprotective drug for type 2 diabetes
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DOI：
10.1177/1479164118825376
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发表时间：
2019-03-01
影响因子：
2.4
通讯作者：
Nissen, Steven E.
中科院分区：
文献类型：
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作者：
DeFronzo, Ralph A.;Inzucchi, Silvio;Nissen, Steven E.
2型糖尿病患者发生大血管并发症的风险很高：心肌梗死、中风和心血管死亡率。最近的心血管结局试验表明，两类降糖药物（SGLT 2抑制剂和GLP-1受体激动剂）可减少主要心血管不良事件。然而，在大型随机前瞻性心血管结局试验（IRIS和PROactive）中，有强有力的证据表明，一种较老的、现在已普遍上市的药物噻唑烷二酮吡格列酮可以延缓动脉粥样硬化过程（PERISCOPE和芝加哥），并减少心血管事件。吡格列酮是一种有效的胰岛素增敏剂，可保护β细胞功能，导致HbA 1c持久降低，纠正代谢综合征的多个组分，并改善非酒精性脂肪肝/非酒精性脂肪性肝炎。必须考虑不良反应（体重增加、液体潴留、骨折），但随着剂量的降低，不良反应会减少，并且可以说这些多重益处超过了不良反应。由于糖尿病的医疗费用迅速增加，这种具有成本效益的药物需要重新考虑这种疾病的治疗设备。
Type 2 diabetes individuals are at high risk for macrovascular complications: myocardial infarction, stroke and cardiovascular mortality. Recent cardiovascular outcome trials have demonstrated that agents in two antidiabetic classes (SGLT2 inhibitors and GLP-1 receptor agonists) reduce major adverse cardiovascular events. However, there is strong evidence that an older and now generically available medication, the thiazolidinedione, pioglitazone, can retard the atherosclerotic process (PERISCOPE and Chicago) and reduce cardiovascular events in large randomized prospective cardiovascular outcome trials (IRIS and PROactive). Pioglitazone is a potent insulin sensitizer, preserves beta-cell function, causes durable reduction in HbA1c, corrects multiple components of metabolic syndrome and improves nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. Adverse effects (weight gain, fluid retention, fractures) must be considered, but are diminished with lower doses and are arguably outweighed by these multiple benefits. With healthcare expenses attributable to diabetes increasing rapidly, this cost-effective drug requires reconsideration in the therapeutic armamentarium for the disease.