Thiazolidinediones and cardiovascular disease.

Thiazolidinediones hold promise for reducing cardiovascular events and human atherosclerosis. Similar to statins and angiotensin-converting enzyme inhibitors, peroxisome proliferator activated receptor gamma (PPARgamma) exerts anti-inflammatory and antiatherosclerotic actions in the vessel wall. A number of clinical trials in subjects with or without diabetes have shown that thiazolidinedione therapy can reduce in-stent restenosis and delay progression of atherosclerosis measured by carotid artery ultrasound. PPARgamma directly promotes expression of ATP-binding cassette transporter G1, mediating cellular cholesterol efflux to high-density lipoproteins from macrophages, which may further explain the potential cardiovascular benefit of this class. Whether the benefits observed in animal models will translate in clinical practice is being evaluated in several large, randomized controlled trials.