Thiazolidinedione May Make PAD Procedure More Effective in Diabetics

shutterstock_180113171A new study, entitled “Retrospective review of superficial femoral artery stenting in diabetic patients: thiazolidinedione use may decrease reinterventions” suggests that the use of thiazolidinediones decreases the rate of target lesion revascularization re-interventions in diabetic patients. The study was published in the journal BMC Cardiovascular Disorders.

Diabetic patients have increased chances of developing lower extremity peripheral artery disease (PAD), a condition characterized by blocked arteries in the legs. The most common early symptom of PAD is intermittent claudication, a tight, aching pain that occurs in the lower leg due to inadequate blood flow to the muscles (due to narrowing of the arteries by atherosclerosis) and is felt while walking and becomes less intense with rest. One treatment possibility is performing superficial femoral artery (SFA) stenting (the main artery in the thigh). A stent is a small mesh tube that is inserted to treat narrow or weak arteries. However, diabetes is frequently associated with poor outcomes after SFA stenting, resulting in the necessity for re-intervention. The reason for the associated poor clinical outcome of these patients after stenting is currently unclear. In this study, the authors performed a retrospective analysis and determined how the use of thiazolidinediones (TZDs, a class of drugs used in the treatment of diabetes mellitus type 2) impacts the necessity for re-intervention in diabetic patients.

The authors analyzed 128 diabetic patients who were stratified by TZD use and then evaluated the necessity for target lesion revascularization (TLR) within the first twelve months (at the first, sixth and twelfth month) and every year thereafter. They found that diabetic patients that take TZDs when submitted to the first SFA stenting exhibit a lower rate of re-interventions in the first two years. Additionally, the authors confirmed previous studies that insulin use and critical limb ischemia (a severe blockage in the arteries of lower extremities, markedly reducing blood-flow) is associated with increased TLR intervention. Their results are in agreement with previous data obtained from cardiovascular stent interventions in diabetic patients, with TZD use diminishing the necessity of re-interventions in these patients. The team of researchers highlight their findings should be further confirmed in larger databases. The authors propose the beneficial effect of TZDs is related to their anti-inflammatory effects, however, further studies are needed to confirm this hypothesis. Since TZDs are peroxisome proliferator-activatory receptor-gamma (PPAR-gamma) agonists the authors suggest information should be registered for other agonists, such as cilostazol and fibrates.

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