Effect of rosiglitazone, metformin and medical nutrition treatment on arterial stiffness, serum MMP-9 and MCP-1 levels in drug naive type 2 diabetic patients.

The aim of the study was to evaluate the long-term effect of rosiglitazone and metformin monotherapy with medical nutrition treatment (MNT) and of MNT alone on arterial stiffness, serum monocyte chemoattractant protein (MCP)-1 and matrix metalloproteinase (MMP)-9 in drug naive patients with type 2 diabetes mellitus. Fifty type 2 diabetic patients were randomized to receive rosiglitazone 4 mg/day (n=19) or metformin 850 mg/day (n=16) with MNT or MNT alone (n=15), for 52 weeks. Arterial stiffness was assessed by using large and small artery elasticity index (SAEI and LAEI, respectively). SAEI, LAEI, serum MCP-1 and MMP-9 levels were measured at baseline and following 52 weeks of treatment. SAEI was improved only in the rosiglitazone group, and the difference was still statistically significant when the three groups were compared (p=0.024). There were no differences in LAEI in inter- and intragroup comparisons at the end of the study. Serum MMP-9 levels were decreased in the metformin (-13.5+/-34.8%, p=0.02) and rosiglitazone (-27.2+/-51.0%, p=0.023) groups compared with baseline values, whereas no significant change was seen in serum MCP-1 levels. These results suggest that rosiglitazone monotherapy has favorable effects on arterial stiffness compared with metformin monotherapy independent of glycemic control.

Small arterial elasticity predicts the extent of coronary artery disease: Relationship with serum uric acid.

BACKGROUND: Arterial elasticity has been previously linked to atherosclerotic vascular disease states. Serum uric acid level has been recently associated with increased arterial stiffness, but to what extent serum uric acid reflects angiographic coronary artery status and vessel compliance remains to be established. In this study we aimed to evaluate the association of arterial elasticity indexes, serum uric acid and the presence and extent of angiographic coronary artery disease (CAD) in patients with chronic stable angina. METHODS: One hundred and eight consecutive patients attending for elective coronary angiography were investigated. The severity of CAD was expressed using the Gensini score. Quantitative analysis of the arterial elasticity was performed by applanation tonometry. Serum uric acid was measured in all participants. Stepwise multiple linear regression analysis was used to identify the independent correlates of the Gensini score. RESULTS: After adjustment for age, gender, common cardiac risk factors and cardiovascular drugs, small artery elasticity index (SAEI) (p<0.001) and serum uric acid (p<0.001) were independently correlated with the severity of CAD. Stepwise multiple linear regression analysis was also used to identify independent correlates of the SAEI. Serum uric acid emerged as the only independent correlate of SAEI (p<0.001). CONCLUSIONS: SAEI independently reflects the extent of CAD in patients with chronic stable angina. This relationship is chiefly mediated by serum uric acid. Our data add to the growing evidence that serum uric acid may be a marker of arterial stiffness and atherosclerotic burden.

Arterial elasticity and plasma levels of adiponectin and leptin in type 2 diabetic patients treated with thiazolidinediones.

BACKGROUND: Thiazolidinediones (TZDs) improve peripheral insulin sensitivity, but the effect on arterial stiffness is less clear. The aim of the present study was to assess the differential effect of pioglitazone or rosiglitazone on arterial stiffness and plasma levels of adiponectin and leptin in patients with type 2 diabetes mellitus. METHODS: Thirty-five type 2 diabetic subjects were randomly assigned to receive pioglitazone (30 mg/day; n = 14), rosiglitazone (4 mg/day; n = 11), or placebo (medical nutrition therapy; n = 10) for 12 weeks. Changes in plasma glucose, glycosylated hemoglobin, insulin resistance (HOMA-IR), total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, adiponectin, and leptin were evaluated at baseline and after 12 weeks. In parallel, large arterial compliance (C1) and small arterial compliance (C2) were measured at baseline and at the end of treatment period. RESULTS: At 12 weeks, the rosiglitazone (P = 0.026) and pioglitazone (P = 0.004) groups had a significant increase from baseline in adiponectin that was not seen in the medical nutrition therapy group. No significant changes in plasma leptin and in C1 and C2 elasticity indexes were observed over the entire study period in any of the treatment groups. CONCLUSIONS: In this study of patients with type 2 diabetes, treatment with TZDs was associated with a significant improvement in adiponectin levels, although no significant effects were seen on leptin levels and arterial elasticity.