Clinical effectiveness of pioglitazone in the combination treatment of patients with asthma concurrent with coronary heart disease

Full Text


Aim. To investigate the clinical effectiveness of pioglitazone in the combination treatment of patients with asthma concurrent with coronary heart disease (CHD). Subjects and methods. Fifty patients aged 40-75 years with asthma concurrent with CHD were examined. External respiratory function (ERF), electrocardiograms, blood pressure (BP), and anthropometric measurements were assessed in all the patients. Blood and urine laboratory values and high-sensitivity C-reactive protein (hs-CRP) concentrations were estimated; endothelial function was determined measuring endothelium-dependent and endothelium-independent vasodilation (EDVD and EIVD). The patients were randomized into a comparison group receiving only standard therapy and a study group taking pioglitazone as part of combination therapy for 3 months. Results. At the randomization stage prior to pioglitazone combination therapy, the patient groups did not statistically significantly differ in basic clinical and anamnestic data. Three-month standard therapy resulted in stabilization of ERF and endothelial function. During the treatment, there were increases in the frequency of asthma symptoms and the duration of angina attacks, however, there was a decline in hs-CRP levels (p<0.001). Incorporation of pioglitazone into the standard treatment regimen of patients with asthma concurrent with CHD improved clinical disease control, decreased the degree of bronchial obstruction and the frequency of angina pain and asthma attacks using nitroglycerin and salbutamol, lowered systolic and diastolic blood pressure, improved EDVD (increases in the maximum linear velocity of blood flow after a test for reactive hyperemia (RH), index of reactivity (IR), and Δ% brachial artery (BA) diameter) and EIVD (increases in IR and Δ% BA diameter), and reduced systemic inflammation from hs-CRP values (p<0.001) and hypercholesterolemia from total cholesterol levels (p<0.02). Conclusion. The incorporation of pioglitazone in the combination therapy of patients with asthma concurrent with CHD improves the clinical course of the diseases and increases their control, reduces systemic inflammation, and improves endothelial functional activity.


  1. Белан О.В., Кайдашев И.П., Борзых О.А. Особенности формирования факторов риска, системного воспаления и эндотелиальной дисфункции у пациентов при бронхиальной астме в сочетании с ишемической болезнью сердца. Терапевтический архив. 2014;3:34-39.
  2. Кайдашев И.П. NF-κB-сигнализация как основа развития системного воспаления, инсулинорезистентности, липотоксичности, сахарного диабета 2-го типа и атеросклероза. Международный эндокринологический журнал. 2011;3(35):35-38.
  3. Будовская Л.А. Механизмы воспаления при сочетании бронхиальной астмы и ишемической болезни сердца. Украинский пульмонологический журнал. 2012;1:68-73.
  4. Бродская Т.А., Невзорова В.А., Гельцер Б.И., Моткина Е.В. Дисфункция эндотелия и болезни органов дыхания. Терапевтический архив 2007;3:76-84.
  5. Ricote M, Glass CK. PPARs and molecular mechanisms of transrepression. Biochim Biophys Acta. 2007;1771(8):926-935.
  6. Кайдашев И.П., Куценко Н.Л. Рецепторы, активирующие пролиферацию пероксисом, как возможная мишень в лечении аллергических заболеваний. Клиническая иммунология, аллергология, инфектология. 2008;3(14):59-63.
  7. Zhang WY, Schwartz EA, Permana PA, Reaven PD. Pioglitazone inhibits the expression of inflammatory cytokines from both monocytes and lymphocytes in patients with impaired glucose tolerance. Arterioscler Thromb Vasc Biol. 2008;28(12):2312-2318.
  8. Gizard F, Bruemmer D. Transcriptional control of vascular smooth muscle cell proliferation by Peroxisome Proliferator-Activated Receptor-: Therapeutic implications for cardiovascular diseases. PPAR Res. 2008;28:1-11.
  9. Xing B, Xin T, Hunter RL, Bing G. Pioglitazone inhibition of lipopolysaccharide-induced nitric oxide synthase is associated with altered activity of p38 MAP kinase and PI3K/Akt. J Neuroinflam. 2008;5:1-4.
  10. Erdmann E, Charbonell B, Wilcox P. Thiazolidindiones and cardiovascular risk — a question of balance. Curr Cardiol Rev. 2009;5(3):155-165.
  11. Betteridge DJ. CHICAGO, PERISCOPE and PROactive: CV risk modification in diabetes with pioglitazone. Fundam Clin Pharmacol. 2009;23(6):675-679.
  12. Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention (updated 2009, 2012).
  13. Celermajer DS, Sorensen KE, Gooch VM, Spiegelhalter DJ, Miller OI, Sullivan ID, Lloyd JK, Deanfield JE. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet. 1992;340:1111-1115.
  14. Yildiz P, Oflaz H, Cine N et al. Endothelial dysfunction in patients with asthma: the role of polymorphisms of ACE and endothelial NOS genes. J Asthma. 2004;41(2):159-166.
  15. Кароли Н.А, Ребров А.П. Легочная гипертензия и состояние правых отделов сердца у больных бронхиальной астмой. Пульмонология. 2003;13(2):21-25.
  16. Gupta A, Badyal DK, Khosla PP et al. Effect of atorvastatin on hs-CRP in acute coronary syndrome. Br J Clin Pharmacol. 2008;66(3):411-413.
  17. DeFronzo RA, Tripathy D, Schwenke DC et al. Pioglitazone for Diabetes prevention in impaired glucose tolerance. N Engl J Med. 2011;364:1104-1115.
  18. Винник Н.И., Куценко Л.А., Куценко Н.Л., Мамонтова Т.В., Гординская И.Л., Микитюк М.В., Шлыкова О.А., Веснина Л.Э., Кайдашев И.П. Особенности клинической эффективности применения пиоглитазона в комплексной терапии больных с ишемической болезнью сердца на фоне метаболического синдрома. Артериальная гипертензия. 2011;1:79-86.
  19. Park SJ, Lee KS, Kim SR, Min KH, Choe YH, Moon H, Chae HJ, Yoo WH, Lee YC. Peroxisome Proliferator-Activated Receptor γ agonist down-regulates IL-17 expression in a murine model of allergic airway inflammation. J Immunol. 2009;183(5):3259-3267.
  20. El-Sakkar MG, Barghash A. The efficacy of simvastatin and pioglitazone in murine model of chronic bronchial asthma. BullAlex Fac Med. 2006;42(2):519-529.
  21. Hanefeld M, Marx N, Pfützner A, Baurecht W, Lübben G, Karagiannis E, Stier U, Forst T. Anti-inflammatory effects of pioglitazone and/or simvastatin in high cardiovascular risk patients with elevated high sensitivity C-Reactive Protein. The PIOSTAT Study. JACC. 2007;49(3):290-297.
  22. Hettihewa LM, Jayasighe SS, Imendra KG, Weeraratha TP. Correlation between changes of blood pressure with insulin resistance in type 2 diabetes mellitus with 4 weeks of pioglitazone therapy. Int JDiabetes Dev Ctries. 2008;28(1):26-30.



Abstract: 157

Article Metrics

Metrics Loading ...


  • There are currently no refbacks.

Copyright (c) 2015 Byelan O.V., Borzykh O.A., Mamontova T.V., Kaidashev I.P.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Address of the Editorial Office:

  • Novij Zykovskij proezd, 3, 40, Moscow, 125167

Correspondence address:

  • Novoslobodskaya str 31c4., Moscow, 127005, Russian Federation

Managing Editor:


© 2018-2021 "Consilium Medicum" Publishing house

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies