Author + information
- David S.H. Bell, MD⁎ ( and )
- James H. O'Keefe, MD
- ↵⁎Southside Endocrinology, 1020 26th Street South, Room 204, Birmingham, Alabama 35205
Nicholls et al. (1), based on data from the PERISCOPE (Pioglitazone Effect on Regression of Intravascular Sonographic Coronary Obstruction Prospective Evaluation) study, reported that the favorable effects of pioglitazone on the triglyceride-to-high-density lipoprotein (trig/HDL) ratio correlated with delayed atheroma progression in diabetic patients. Nowhere in the paper do the authors recognize the association of the trig/HDL ratio with insulin resistance and the other manifestations of the metabolic syndrome. The trig/HDL ratio is a simple way to identify insulin-resistant individuals at increased risk of cardiovascular disease and has also been shown to predict the low-density lipoprotein particle size in Asian Indians (2–4).
Therefore, it is highly likely that the effect of pioglitazone in decelerating the formation of coronary artery atheroma was at least in part due to pioglitazone's ability to lower insulin resistance, which in turn reduces inflammation and post-prandial glucose—2 other potent and independent risk factors for atherosclerotic progression and adverse cardiovascular events (5,6).
- American College of Cardiology Foundation
- Nicholls S.J.,
- Tuzcu E.M.,
- Wolski K.,
- et al.