Background: There is evidence that rosiglitazone may increase cardiovascular risk and, on this basis, this agent has been recently advised for treatment of type-2 diabetes. Yet, its effects on fasting and postprandial atherogenic dyslipidemia are still not fully elucidated.
Methods: In an open-label study rosiglitazone (4 mg/day for 12 weeks) was added on top of a maximum of two oral antidiabetic drugs to 18 patients with adequately controlled type-2 diabetes (HbA1c: 6.58.0%), evaluating the effects on plasma lipids and lipoproteins before and after an oral fat load. Low-density lipoproteins (LDL) and high-density lipoproteins (HDL) size and subclasses were determined by gradient gel electrophoresis.
Results: Rosiglitazone improved HbA1c (P=0.0023), while no significant changes were found in plasma lipids or lipoprotein (a), both fasting and post-prandially. Fasting LDL size increased after therapy (+1.4%, P=0.0338), due to a reduction in small, dense LDL-IIIA particles (−25.1%, P=0.0180). Postprandially, rosiglitazone reduced larger HDL-2b (−8.7%, P=0.0056) and increased smaller HDL-3b particles (+12.2%, P=0.0485), with no changes in HDL size. No other effects on lipoproteins size and subclasses were found fasting or post-prandially. By correlation analysis we further found that such changes in lipoproteins size and subclasses were not related to changes in HbA1c or plasma lipids.
Conclusions: Rosiglitazone therapy in patients with type-2 diabetes led to anti-atherogenic changes in LDL size and subclasses, with concomitant pro-atherogenic changes in HDL subclasses, despite no effects on plasma lipids and lipoprotein (a). Further studies may evaluate whether these findings affect the clinical endpoints in such patients.
Prague, Czech Republic
24 - 28 Apr 2010
European Society of Endocrinology