A randomized placebo controlled double blind crossover study of pioglitazone on left ventricular diastolic function in type 2 diabetes

Background/ObjectivesThiazolidinediones (TZDs), such as pioglitazone, are widely used to treat type 2 diabetes but there is evidence that their use is associated with an increased risk of heart failure. We compared the effect of pioglitazone vs. placebo on left ventricular (LV) diastolic and systolic function in people with type 2 diabetes.Methods and results24 male or female patients with type 2 diabetes were randomized to pioglitazone (45 mg/day) or placebo in addition to current therapy for 12 weeks using a prospective double blind crossover protocol following a run-in period > 1 week and a 2 week washout period at crossover. Tissue Doppler early peak velocity (e′), a measure of LV diastolic function, was the primary outcome. Pioglitazone significantly increased e′ by 0.7(0.1, 1.3) cm/s (mean (95% confidence interval); p = 0.02) compared with placebo. Pioglitazone also increased E/A and mitral deceleration index, ejection fraction, stroke volume and weight, whereas fasting glucose, HbA1c, total peripheral resistance and LV meridional end systolic stress were decreased.ConclusionsTreatment with pioglitazone for 12 weeks improves left ventricular diastolic and systolic function in people with type 2 diabetes.