Purpose of review: To chart recent progress on molecular mechanisms of rosiglitazone and pioglitazone in the cardiovascular system.
Recent findings: Several classes of oral antidiabetic drugs are available to treat type 2 diabetes, but glitazones offer the unique promise of insulin-sensitizing ability coupled with potential to reverse cardiovascular abnormalities associated with insulin resistance. Currently the two drugs used are rosiglitazone and pioglitazone, marketed as Avandia and Actos. Recent results of different metaanalyses were inconclusive as to whether rosiglitazone caused real adverse effects of myocardial ischemia. Thus, the US Food and Drugs Administration placed a black box warning on Avandia to signal potential of myocardial infarction and heart-related deaths, as a precautionary measure until analyses of all available data provide clarity. Also unresolved is the extent to which the two compounds share modes of action.
Summary: Type II diabetes affects more than 160 million people, approximately 5% of the world's population (http://www.who.org). Recently, questions have been raised about the cardiovascular safety of glitazone antidiabetic drugs. Clearly, there is an urgency to define molecular mechanisms of rosiglitazone and pioglitazone and understand how these drugs may impact patients.