Peroxisome proliferator-activated receptor gamma agonists: Their role as vasoprotective agents in diabetes

Both type I and type 2 diabetes mellitus are associated with increased cardiovascular morbidity and mortality, and now affect more than 170 million individuals worldwide. The incidence of type 2 diabetes is growing rapidly and now accounts for 90 to 95 percent of all diabetes cases. Thiazolidinediones (TZDs), a class of insulin sensitizing agents commonly used in the treatment of patients who have type 2 diabetes, improve endothelial dysfunction and exert beneficial effects on lipid profiles by activating the nuclear receptor peroxisome proliferator-activated receptor gamma (PPAR-gamma). In addition, TZDs exhibit antiatherogenic effects, independent of their antidiabetic and lipid-lowering properties, by attenuating proinflammatory processes. The combination of increased insulin sensitivity, improved lipid profile, and reduced inflammation may explain the cardiovascular benefits of this class of drugs.