Pioglitazone Reduces the Necrotic-Core Component in Coronary Plaque in Association With Enhanced Plasma Adiponectin in Patients With Type 2 Diabetes Mellitus

Background Pioglitazone has a preventive effect on cardiovascular disease, but its ability to stabilize coronary plaque is unknown. Methods and Results A prospective, randomized trial was conducted in 54 patients with type 2 diabetes and stable angina pectoris, randomly assigned to either a pioglitazone group or control group. Non-culprit, angiographically mild-to-moderate obstructive lesions were examined with virtual histology intravascular ultrasound (VH-IVUS) at coronary intervention and 6 months later. In total, 42 lesions of 22 patients in the pioglitazone group and 44 lesions of 24 patients in the control group were analyzed. After 6 months, patients in the pioglitazone group had significantly improved blood sugar, high-sensitivity C-reactive protein, and plasma adiponectin levels. VH-IVUS analysis revealed that, although the total plaque-to-vessel volume was not changed in either group, the necrotic-core area had significantly decreased in the pioglitazone group (-4.6 +/- 5.9% vs 1.1 +/- 9.3%, P=0.001). There was a significant inverse correlation between the change in plasma adiponectin levels and the change in necrotic-core area (r=-0.46, P < 0.0001). Conclusions Pioglitazone may stabilize coronary plaque by reducing the necrotic-core component, in association with enhanced plasma adiponectin levels. (Circ J 2009; 73: 343-351)