Effect of thiazolidinediones on in-stent restenosis in patients after coronary stenting: A meta-analysis of randomized controlled trials
Section snippets
Search strategy
Electronic databases including PubMed (1966–May 2007), EMBase (1980–May 2007), BIOSIS Previews (1997–week 16, 2007), and Cochrane central register of controlled trials (2nd Quarter 2007) were searched by using the Mesh and text keywords thiazolidinediones, pioglitazone, rosiglitazone, percutaneous coronary intervention, stent and restenosis. References from these trials were scrutinized to reveal additional citations. Conference proceedings from American College of Cardiology (2003–2006),
Study selection
Eight RCTs (6 RCTs in full-text publications [11], [12], [13], [14], [15], [16] and 2 RCTs in conference abstracts [17], [18]) with 366 intention-to-treat (ITT) participants were identified for inclusion from 420 potentially relevant publications. Among these trials, 5 trials [11], [12], [13], [14], [18] included 261 diabetic patients and 3 trials [15], [16], [17] recruited 105 non-diabetic (metabolic syndrome, normal or impaired glucose tolerance) patients.
Baseline characteristics and study quality
Table 1 summarizes the baseline
Discussion
This meta-analysis illustrates that TZDs therapy for 6 months after coronary stenting significantly reduces the risk of ISR, diameter stenosis, late lumen loss, and neointimal area/volume in both diabetic and non-diabetic patients.
The effect of TZDs therapy on the risk of TLR is inconsistent when including or excluding the conference abstracts. The reasons were as followings. First, the sample size, especially in non-diabetic population, was relatively small, so the outcome was greatly affected
Conclusions
In conclusion, our study suggests that TZDs therapy is an effective strategy in preventing ISR in both diabetic and non-diabetic patients with coronary stent implantation. More studies, especially large multi-centre RCTs, are still warranted to further clarify the anti-restenotic effect of TZDs therapy.
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2017, AtherosclerosisCitation Excerpt :A recent multi-center clinical trial in non-diabetic insulin resistant patients with a previous history of transient ischemic attack or stroke demonstrated that risk of stroke and myocardial infarction was lower among patients who received pioglitazone than those who received placebo. A meta-analysis of six randomized clinical trials (4 on pioglitazone and 2 on rosiglitazone) in diabetic and non-diabetic patients after coronary stent implantation demonstrated that those who received TZDs in addition to standard therapy were less likely to undergo revascularization due to stent restenosis at 6-month follow-up [54]. It is noteworthy that despite proven beneficial effect of pioglitazone in reducing myocardial infarction, stroke, and cardiovascular mortality in patients with type II diabetes [55–58], there is conflicting data regarding possible increased risk of myocardial infarction, with no change in cardiovascular mortality, with use of rosiglitazone [59].
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2012, Journal of Lipid ResearchCitation Excerpt :Other studies have investigated whether TZDs affect postinfarction left ventricular remodeling. The evidence is mixed, with some studies demonstrating reduced postinfarction fibrosis and improved systolic function (152, 153), while others show neutral or adverse effects on left ventricular remodeling and survival (154, 155). Rodent studies suggest that cerebral ischemia/reperfusion injury may also be favorably modified by PPAR-γ activation, manifest by improved recovery of neurologic function and/or decreased infarct size (156–161).
Effects of Thiazolidinediones on Cardiovascular Events in Patients With Type 2 Diabetes Mellitus After Drug-Eluting Stent Implantation: A Retrospective Cohort Study Using the National Health Insurance Database in Taiwan
2012, Clinical TherapeuticsCitation Excerpt :Based on the literature search we performed focusing on TZD and stent restenosis before 2011, previous studies mainly focused on the relationship between BMSs and TZDs. Meta-analyses by Geng et al13 and Rosmarakis et al14 reported that TZD therapy effectively prevented in-stent restenosis in both diabetic and nondiabetic patients who underwent coronary stenting. Takagi et al15 also concluded that in type 2 diabetic patients who underwent BMS surgery, pioglitazone treatment might suppress in-stent neointimal proliferation and reduce the risk of target lesion revascularization.
Effect of alpha-glucosidase inhibitors on the progression of carotid intima-media thickness: A meta-analysis of randomized controlled trials
2011, AtherosclerosisCitation Excerpt :Studies were considered for inclusion if they met the following criteria: (1) type of study design was randomized controlled trials (RCTs); (2) type of participants was those with IGT or diabetes; (3) type of intervention was an alpha-GI in comparison with placebo, no treatment or other hypoglycemic agents; (4) type of primary outcome was the progression of carotid IMT at follow-up and (5) study duration ≥1year. Studies that compared alpha-GIs with thiazolidinediones on this issue were excluded due to the anti-atherosclerotic effect of thiazolidinediones [13,14]. The primary outcome measures were the annual change in carotid IMT and the change in carotid IMT at the end of follow-up.
Role of pioglitazone in the prevention of restenosis and need for revascularization after bare-metal stent implantation: A meta-analysis
2011, JACC: Cardiovascular InterventionsPhenotypic switching of vascular smooth muscle cells in atherosclerosis, hypertension, and aortic dissection
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Department of Cardiology, The Second Affiliated Hospital, Sun Yat-sen University, No. 107 West Yanjiang Road, Guangzhou 510120, China.