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RESEARCH PRODUCT

The differential effects of thiazolidindiones on atherogenic dyslipidemia in type 2 diabetes: what is the clinical significance?

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Diabetic dyslipidemia is typically characterized by an increase in plasma triglycerides, a decrease in high-density lipoprotein cholesterol and a concomitant increase in atherogenic small dense low-density lipoproteins. Thiazolidindiones are able to lower the levels of fasting glucose and glycated hemoglobin significantly by improving insulin sensitivity, as well as improving some aspects of diabetic dyslipidemia: total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol tend to increase while triglycerides are generally decreased.This paper reviewed the effects of pioglitazone and rosiglitazone on atherogenic diabetic dyslipidemia, in particular on small dense low-density lipoprotein particles.A literature search (by Medline and Scopus) was performed up to 15 March 2008. The authors also manually reviewed the references of selected articles for any pertinent material.Pioglitazone showed an additional beneficial effect on triglycerides, high-density lipoprotein cholesterol and the levels of small dense low-density lipoprotein compared to rosiglitazone.Since recent studies have suggested that these agents may also have a differential effect on long-term cardiovascular end-points despite similar improvements in glycated hemoglobin and insulin sensitivity, the different impact on atherogenic diabetic dyslipidemia may help to explain these findings.