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Rosiglitazone May Improve Small Artery Elasticity in Patients With Diabetes

Treatment with rosiglitazone may decrease hyperinsulinemia and, as a result, improve small artery elasticity, according to the findings of an open-label study.

Hyperinsulinemia and insulin resistance (IR) play a major role in the pathogenesis of non-insulin dependent diabetes mellitus (NIDDM) and tissue damage, the authors note. In addition, diabetic patients have high rates of hypertension, dyslipidaemia, obesity, and an increased prevalence of vascular complications.

Marina Shargorodsky, MD, with Departments of Department of Endocrinology and Diabetes at the Wolfson Medical Center, Holon, Israel, and colleagues hypothesised that glitazones may improve IR and reduce hyperinsulinemia and therefore reduce these complications.

To test their theory, they recruited 52 patients with NIDDM and at least one additional cardiovascular risk factor. Patients were treated for 6 months with 4 mg per day of rosiglitazone. The dose was increased to 8 mg after 3 months of treatment if needed.

Blood insulin and C-peptide levels and urine protein levels were measured at the beginning and end of the study. Glucose, chemistry, lipid profile, and haemoglobin A1C were measured at 0, 3, and 6 months, and vascular compliance was measured each month.

Rosiglitazone increased small artery elasticity significantly, with a mean increase of up to 50% during monthly follow-up in comparison to baseline measurements (p<0.001). Large artery elasticity tended to increase toward the end of the study, but the change was not significant.

Systolic blood pressure decreased from 144 to 124 mmHg, and diastolic blood pressure decreased from 80 to 68 mmHg, despite the patients' weight gain (p= 0.00008). Decrease in heart rate was not significant.

Systemic vascular resistance decreased from 1789.8 to 1329.4 dyne sec/cm⁵ (p=0.0001). In patients not treated with insulin, plasma insulin decreased from 42.45 ± 24.90 to 27.86 ± 14.86 IU/mL (p=0.0001).

"Because rosiglitazone improves insulin receptor sensitivity (IRS), it is logical to assume that the reduction in hyperinsulinemia reflects improvement in IRS," they conclude.

"These findings comply with the theory that hyperinsulinemia and insulin resistance participate in the development of tissue damage, a progressive decrease in small artery elasticity," they add.
Am J Hypertens 2003;16:8:617-22. "Treatment with rosiglitazone reduces hyperinsulinemia and improves arterial elasticity in patients with type 2 diabetes mellitus"

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