Investigation of the vascular and pleiotropic effects of atorvastatin and pioglitazone in a population at high cardiovascular risk

Diab Vasc Dis Res. 2008 Nov;5(4):298-303. doi: 10.3132/dvdr.2008.043.


We investigated the effect of atorvastatin monotherapy and combined treatment with atorvastatin and pioglitazone on intima-media thickness, vascular function and the cardiovascular risk profile. In all, 148 patients (76 male, 72 female; aged 61.4+/-6.5 years; body mass index [BMI] 29.2+/-4.1 kg/m2; mean +/- SD) with increased cardiovascular (CV) risk factors were randomised. Intima-media thickness (IMT), the augmentation index (Aix@75), the microvascular response to acetylcholine (LDF), lipid status, and plasma levels of intact proinsulin, adiponectin, interleukin-6 (IL-6), monocyte chemotactic protein-1 (MCP-1), matrix metalloproteinase-9 (MMP-9), sCD40L, P-selectin, tissue plasminogen activator (t-PA) and blood lipids were monitored over six months. Atorvastatin treatment, alone and in combination with pioglitazone, revealed a significant regression in IMT (0.923+/-0.013 to 0.874+/-0.012 mm and 0.921+/-0.015 to 0.882+/-0.015 mm; mean +/- SEM; p<0.05 respectively) and Aix@75 (27.3+/-1.2 to 25.9+/-1.4; and 25.6+/-1.4 to 24.8+/-1.7%; p<0.05). The endothelial response to acetylcholine as measured by laser Doppler fluximetry (LDF) improved during combined treatment (373+/-57 to 576+/-153 AU; p<0.05). Addition of pioglitazone to atorva-statin resulted in significant further effects on high-sensitivity C-reactive protein (hsCRP), t-PA, P-selectin, adiponectin, triglycerides and high-density lipoprotein (HDL) cholesterol (p<0.05 respectively). Atorvastatin significantly improved IMT and vascular elasticity. Co-administration of pioglitazone provided additional effects on endothelial function, lipid profile and laboratory markers of inflammation.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Atherosclerosis / complications
  • Atherosclerosis / drug therapy*
  • Atherosclerosis / physiopathology
  • Atorvastatin
  • Blood Pressure / drug effects
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / prevention & control*
  • Carotid Artery, Common / diagnostic imaging
  • Carotid Artery, Common / drug effects
  • Double-Blind Method
  • Drug Therapy, Combination
  • Female
  • Germany
  • Heptanoic Acids / therapeutic use*
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
  • Inflammation Mediators / blood
  • Lipids / blood
  • Male
  • Microcirculation / drug effects
  • Middle Aged
  • Pioglitazone
  • Prospective Studies
  • Pyrroles / therapeutic use*
  • Radial Artery / drug effects
  • Radial Artery / physiopathology
  • Risk Assessment
  • Skin / blood supply
  • Thiazolidinediones / therapeutic use*
  • Treatment Outcome
  • Ultrasonography


  • Heptanoic Acids
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Inflammation Mediators
  • Lipids
  • Pyrroles
  • Thiazolidinediones
  • Atorvastatin
  • Pioglitazone