Therapeutic regimens for type 2 diabetes that include pioglitazone are associated with a significantly reduced risk for myocardial infarction and stroke compared with non-thiazolidinedione therapies, according to a presentation at the annual meeting of the European Association for the Study of Diabetes.

The unique outcomes, including some clinical practice results, reinforce the consistency of pioglitazone data and underscore that pioglitazone has different effects from the other thiazolidinedione, rosiglitazone, due to differences in molecular structure.

A retrospective analysis of case records from a large managed-care database of diabetes patients demonstrated that the adjusted relative risk of stroke for pioglitazone patients was 20 percent lower than for patients who did not take pioglitazone. Likewise, the risk of myocardial infarction over the study period was 38 percent lower in patients receiving pioglitazone than in those taking an anti-diabetes drug regimen without pioglitazone.

John Betteridge, Professor of Endocrinology and Metabolism at University College, London said: "The results of this analysis are very welcome and support the findings from the PROactive study of pioglitazone for secondary prevention of vascular events which showed a reduction in stroke and heart attack in this high risk population."

In addition, the GLAI study, also presented at the meeting, showed the cardioprotective strength of pioglitazone. A new analysis of data from the first three months of this six-month head-to-head study of pioglitazone and rosiglitazone, in which the endpoint was the change in serum lipids, demonstrated that initial treatment with a starting dose of pioglitazone (30 mg) was more effective than a starting dose of rosiglitazone (4 mg) in improving blood glucose (HbA1c) levels and lipid levels.

Also, researchers found that in addition to lowering HbA1c significantly more than rosiglitazone, pioglitazone also significantly decreased triglyceride levels and non-high density lipoprotein cholesterol, and markedly improved high density lipoprotein cholesterol-C levels versus rosiglitazone.

"A likely explanation for the different effects on heart attack and strokes between the two drugs could be the favorable effect of pioglitazone in increasing high density lipoprotein cholesterol without adverse effects on low density lipoprotein cholesterol as demonstrated in the GLAI study," said Betteridge.