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Effects of rosiglitazone on plasma brain natriuretic peptide levels and myocardial performance index in patients with type 2 diabetes mellitus

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Abstract

Thiazolidinediones (TZD) have become a powerful tool for lowering insulin resistance. The problem of cardiovascular adverse events including fluid retention and risk of heart failure should be well known and recognised. We aimed to evaluate the long-term effects of rosiglitazone on cardiac function and fluid dynamics. Forty-six type 2 diabetic patients were randomised to treatment with rosiglitazone or metformin or to a control group. There are no significant differences between the groups in the duration of diabetes, HbA1c, plasma brain natriuretic peptide (BNP) levels, body mass index and myocardial performance indexes (MPIs) before the treatment. After three and six months all these parameters were repeated. Rosiglitazone increased plasma BNP levels and worsened MPIs 3 months after the start of treatment. Also left ventricular end-systolic volume increased and weight gain was observed. But these results were statistically non-significant (all p>0.05). When we continued rosiglitazone treatment to six months the increase in BNP levels became soft and statistically significant improvements were seen in MPIs (p<0.01). Also left ventricular end-systolic volume decreased significantly (p=0.004) and weight gain was stopped. In patients with type 2 diabetes, TZD treatment might have slight adverse effects on ventricular contractility and fluid dynamics at the beginning of the therapy. However, these changes seem to stabilise in the long term.

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References

  1. Reaven G (2002) Metabolic syndrome: pathophysiology and implications for management of cardiovascular disease. Circulation 106:286–288

    Article  PubMed  Google Scholar 

  2. Coats AJ, Anker SD (2000) Insulin resistance in chronic heart failure. J Cardiovasc Pharmacol 35: S9–S14. Erratum in: J Cardiovasc Pharmacol 2001; 38:490 Anker S [corrected to Anker SD]

    Article  PubMed  CAS  Google Scholar 

  3. Mudaliar S, Henry RR (2001) New oral therapies for type 2 diabetes mellitus: the glitazones or insulin sensitizers. Annu Rev Med 52:239–257

    Article  PubMed  CAS  Google Scholar 

  4. Niemeyer NV, Janney LM (2002) Thiazolidinedione-induced edema. Pharmacotherapy 22:924–929

    Article  PubMed  Google Scholar 

  5. Thomas ML, Lloyd SJ (2001) Pulmonary edema associated with rosiglitazone and troglitazone. Ann Pharmacother 35:123–124

    Article  PubMed  CAS  Google Scholar 

  6. Wooltorton E (2002) Rosiglitazone (Avandia) and pioglitazone (Actos) and heart failure. CMAJ 166:219

    PubMed  Google Scholar 

  7. Raskin P, Rendell M, Riddle MC, Dole JF, Freed MI, Rosenstock J; Rosiglitazone Clinical Trials Study Group (2001) A randomized trial of rosiglitazone therapy in patients with inadequately controlled insulin-treated type 2 diabetes. Diabetes Care 24:1226–1232

    Article  PubMed  CAS  Google Scholar 

  8. Hartung DM, Touchette DR, Bultemeier NC, Haxby DG (2005) Risk of hospitalization for heart failure associated with thiazolidinedione therapy: a medicaid claims-based case-control study. Pharmacotherapy 25:1329–1336

    Article  PubMed  CAS  Google Scholar 

  9. Inzucchi SE, Masoudi FA, Wang Y, Kosiborod M, Foody JM, Setaro JF, Havranek EP, Krumholz HM (2005) Insulin-sensitizing antihyperglycemic drugs and mortality after acute myocardial infarction: insights from the National Heart Care Project. Diabetes Care 28:1680–1689

    Article  PubMed  CAS  Google Scholar 

  10. Idris I, Gray S, Donnelly R (2003) Rosiglitazone and pulmonary oedema: an acute dose-dependent effect on human endothelial cell permeability. Diabetologia 46:288–290

    PubMed  CAS  Google Scholar 

  11. Maisel AS, Koon J, Krishnaswamy P, Kazenegra R, Clopton P, Gardetto N, Morrisey R, Garcia A, Chiu A, De Maria A (2001) Utility of B-natriuretic peptide as a rapid, point-of-care test for screening patients undergoing echocardiography to determine left ventricular dysfunction. Am Heart J 141:367–374

    Article  PubMed  CAS  Google Scholar 

  12. Moe GW (2005) BNP in the diagnosis and risk stratification of heart failure. Heart Fail Monit 4:116–122

    PubMed  Google Scholar 

  13. Arnlov J, Ingelsson E, Riserus U, Andren B, Lind L (2004) Myocardial performance index, a Doppler-derived index of global left ventricular function, predicts congestive heart failure in elderly men. Eur Heart J 25:2220–2225

    Article  PubMed  Google Scholar 

  14. Tei C, Ling LH, Hodge DO, Bailey KR, Oh JK, Rodeheffer RJ, Tajik AJ, Seward JB (1995) New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function — a study in normals and dilated cardiomyopathy. J Cardiol 26:357–366

    PubMed  CAS  Google Scholar 

  15. Tei C, Nishimura RA, Seward JB, Tajik AJ (1997) Noninvasive Doppler-derived myocardial performance index: correlation with simultaneous measurements of cardiac catheterization measurements. J Am Soc Echocardiogr 10:169–178

    Article  PubMed  CAS  Google Scholar 

  16. Tekten T, Onbasili AO, Ceyhan C, Unal S, Discigil B (2003) Value of measuring myocardial performance index by tissue Doppler echocardiography in normal and diseased heart. Jpn Heart J 44:403–416

    Article  PubMed  Google Scholar 

  17. Wieczorek SJ, Wu AH, Christenson R, Krishnaswamy P, Gottlieb S, Rosano T, Hager D, Gardetto N, Chiu A, Bailly KR, Maisel A (2002) A rapid B-type natriuretic peptide assay accurately diagnoses left ventricular dysfunction and heart failure: a multicenter evaluation. Am Heart J 144:834–839

    Article  PubMed  CAS  Google Scholar 

  18. Thomas ML, Lloyd SJ (2001) Pulmonary edema associated with rosiglitazone and troglitazone. Ann Pharmacother 35:123–124

    Article  PubMed  CAS  Google Scholar 

  19. Guan Y, Hao C, Cha DR, Rao R, Lu W, Kohan DE, Magnuson MA, Redha R, Zhang Y, Breyer MD (2005) Thiazolidinediones expand body fluid volume through PPARgamma stimulation of ENaC-mediated renal salt absorption. Nat Med 11:861–866

    Article  PubMed  CAS  Google Scholar 

  20. Guan Y, Zhang Y, Davis L, Breyer MD (1997) Expression of perosisome proliferator-activated receptors in urinary tract of rabbits and humans. Am J Physiol 273:F1013–F1022

    PubMed  CAS  Google Scholar 

  21. Yang T, Michele DE, Park J, Smart AM, Lin Z, Brosius FC 3rd, Schnermann JB, Briggs JP (1999) Expression of peroxisomal proliferator-activated receptors and retinoid X receptors in the kidney. Am J Physiol 277:F966–F973

    PubMed  CAS  Google Scholar 

  22. Song J, Knepper MA, Hu X, Verbalis JG, Ecelbarger CA (2004) Rosiglitazone activates renal sodium-and water-reabsorptive pathways and lowers blood pressure in normal rats. J Pharmacol Exp Ther 308:426–433

    Article  PubMed  CAS  Google Scholar 

  23. Ogawa S, Takeuchi K, Ito S (2003) Plasma BNP levels in the treatment of type 2 diabetes with pioglitazone. J Clin Endocrinol Metab 88:3993–3996

    Article  PubMed  CAS  Google Scholar 

  24. Shim WS, Do MY, Kim SK, Kim HJ, Hur KY, Kang ES, Ahn CW, Lim SK, Lee HC, Cha BS (2006) The long term effects of rosiglitazone on serum lipid concentrations and body weight. Clin Endocrinol 65:453–459

    Article  CAS  Google Scholar 

  25. Sartori M, Ceolotto G, Semplicini A (1999) MAPKinase and regulation of the sodium-proton exchanger in human red blood cell. Biochim Biophys Acta 1421:140–148

    Article  PubMed  CAS  Google Scholar 

  26. Hirsch IB, Kelly J, Cooper S (1999) Pulmonary edema associated with troglitazone therapy. Arch Intern Med 159:1811

    Article  PubMed  CAS  Google Scholar 

  27. Takeda K, Ichiki T, Tokunou T, Funakoshi Y, Iino N, Hirano K, Kanaide H, Takeshita A (2000) Peroxisome prolifer-atoractivated receptor gamma activators downregulate angiotensin II type 1 receptor in vascular smooth muscle cells. Circulation 102:1834–1839

    PubMed  CAS  Google Scholar 

  28. Sugawara A, Takeuchi K, Uruno A, Ikeda Y, Arima S, Kudo M, Sato K, Taniyama Y, Ito S (2001) Transcriptional suppression of type 1 angiotensin II receptor gene expression by peroxisome proliferator-activated receptor-gamma in vascular smooth muscle cells. Endocrinology 142:3125–3134

    Article  PubMed  CAS  Google Scholar 

  29. Diep QN, El Mabrouk M, Cohn JS, Endemann D, Amiri F, Virdis A, Neves MF, Schiffrin EL (2002) Structure, endothelial function, cell growth, and inflammation in blood vessels of angiotensin II-infused rats: role of peroxisome proliferator-activated receptor-gamma. Circulation 105:2296–2302

    Article  PubMed  CAS  Google Scholar 

  30. Graf K, Xi XP, Hsueh WA, Law RE (1997) Troglitazone inhibits angiotensin II-induced DNA synthesis and migration in vascular smooth muscle cells. FEBS Lett 400:119–121

    Article  PubMed  CAS  Google Scholar 

  31. Asakawa M, Takano H, Nagai T, Uozumi H, Hasegawa H, Kubota N, Saito T, Masuda Y, Kadowaki T, Komuro I (2002) Peroxisome proliferator-activated receptor gamma plays a critical role in inhibition of cardiac hypertrophy in vitro and in vivo. Circulation 105:1240–1246

    Article  PubMed  CAS  Google Scholar 

  32. Yamamoto K, Ohki R, Lee RT, Ikeda U, Shimada K (2001) Peroxisome proliferator-activated receptor gamma activators inhibit cardiac hypertrophy in cardiac myocytes. Circulation 104:1670–1675

    PubMed  CAS  Google Scholar 

  33. Wang F, Vergara C, Carabino J, Desilets A, Vasquez R (2004) Continuation of thiazolidinedione therapy in patients without left ventricular dysfunction who developed edema and congestive-heart-failure symptoms. Am J Health Syst Pharm 61:1604–1608

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Endocrinology and Metabolism, Başkent University Faculty of Medicine, Fevzi Çakmak Cad. 5. sok no:45, 06490, Bahcelievler, Ankara, Turkey

    Y. Türkmen Kemal, N. Güvener Demirag & A. Dogruk Unal

  2. Department of Cardiology, Başkent University Faculty of Medicine, Ankara, Turkey

    A. Yildirir & A. Atar

  3. Department of Biostatistics, Ankara University Faculty of Medicine, Ankara, Turkey

    Z. Biyiklioglu

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  1. Y. Türkmen Kemal
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  2. N. Güvener Demirag
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  3. A. Yildirir
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  4. A. Atar
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  5. A. Dogruk Unal
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  6. Z. Biyiklioglu
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Correspondence to Y. Türkmen Kemal.

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Türkmen Kemal, Y., Güvener Demirag, N., Yildirir, A. et al. Effects of rosiglitazone on plasma brain natriuretic peptide levels and myocardial performance index in patients with type 2 diabetes mellitus. Acta Diabetol 44, 149–156 (2007). https://doi.org/10.1007/s00592-007-0256-4

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  • DOI: https://doi.org/10.1007/s00592-007-0256-4

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