March 31, 2008 (Chicago) -- The diabetes pill Actos beat out an older diabetes drug, Amaryl, at
slowing the buildup of plaque in the heart arteries of people with type 2
diabetes and cardiovascular disease, researchers report.
Atherosclerosis, or plaque buildup in the inner lining of the arteries, is
particularly aggressive in patients with diabetes, often leading to heart
attacks and strokes. Nearly three-fourths of people with diabetes die from
"This represents, to our knowledge, the first demonstration of the
ability of any blood-sugar-lowering agent to slow the progression of coronary
atherosclerosis in patients with diabetes," says researcher Steven E.
Nissen, MD, chairman of cardiovascular medicine at Cleveland Clinic.
"This will change the paradigm of how we treat people with
diabetes," he tells WebMD. "It's not how much you lower blood sugar,
but how you lower it."
The study was presented at the annual meeting of the American College of
Cardiology and simultaneously released online by The Journal of the American
How Actos and Amaryl Work
Nissen and colleagues studied more than 350 people with type 2 diabetes
and cardiovascular disease. About half were given Actos, a member of a
relatively new class of antidiabetic agents known as thiazolidinediones.
The rest were given Amaryl. It's a member of the class of agents known as
sulfonylureas that have been available for decades and represent one of the
most commonly prescribed classes of diabetic therapy.
Actos and Amaryl work very differently. Actos makes the body more sensitive
to insulin. Amaryl stimulates the pancreas to release more insulin.
Actos carries a "black box" warning that the drug may trigger heart
failure, but it has not been linked to any increased risk of heart
Actos Slows Plaque Buildup
All the participants underwent ultrasounds at the start of the study and
about 18 months later to determine changes in the plaque buildup within the
Results showed that Actos halted the dangerous progression of
atherosclerosis and even started to reverse it, Nissen says. In contrast,
plaque continued to build up in the arteries of patients who took Amaryl.
Additionally, compared with patients on Amaryl, those taking Actos
experienced a 16% increase in HDL "good" cholesterol, a 15% drop in triglyceride levels, and a 45%
drop in blood levels of a marker known as C-reactive protein that is associated
with heart disease.
Past American Heart Association President Sidney Smith, MD, a cardiologist
at the University of North Carolina at Chapel Hill, tells WebMD that the
results are very encouraging.
But he says that he would not recommend that a person with diabetes switch
treatments based on these results.
"The question now is whether the benefit will translate to improved
outcomes," Smith says.
Nissen says that the study was not designed to determine whether Actos
actually cuts the risk of heart attacks and stroke, but he thinks it "will translate into
clinical benefits down the road."
Moving forward, he adds, "We can't just focus on pricking your finger
and getting blood sugar down. The goal in diabetes therapy is to prevent
complications. And the most feared complication is heart disease. I'm thrilled
The study was funded by Takeda Pharmaceuticals, which manufactures
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