Cardiovascular disease is significantly increased in patients with metabolic syndrome
and type 2 diabetes. Several factors such as chronic hyperglycemia, lipId abnormalities,
endothelium dysfunction, inflammation, oxIdative stress, increased thrombosis and
decreased fibrinolysis are likely to promote cardiovascular events in these patients.
Because of positive effects on glucose homeostasis, lipId metabolism, proteins involved
in all stages of atherogenesis, endothelium function, inflammation, thrombosis and
fibrinolysis, PPARS alpha (fibrates) and PPARs gamma (glitazones) agonists are good
candIdates to reduce cardiovascular disease, more precisely in subjects with metabolic
syndrome or type 2 diabetes. PPARS alpha agonists (fibrates) are potent hypolipIdemic
agents increasing plasma HDL-cholesterol and reducing free fatty acIds, triglycerIdes,
LDL-cholesterol and the number of small dense LDL pArticles. Moreover, they reduce
vascular inflammation and thrombosis, promote fibrinolysis and inhibit the production
of the vasoconstrictor factor, endothelin-1, by the endothelium. They have been shown,
in clinical trials, to reduce cardiovascular disease, more particularly in patients
displaying lipId abnormalities typical of metabolic syndrome and type 2 diabetes (high
triglycerIdes, low HDL-cholesterol). PPARS gamma agonists (glitazones) have not only
beneficial effects on glucose homeostasis, by increasing insulin sensitivity and reducing
blood glucose level but also on lipId metabolism by elevating plasma HDL-cholesterol,
decreasing free fatty acIds and the number of small dense LDL pArticles, and for pioglitazone
by reducing plasma triglycerIdes. Furthermore, they diminish vascular inflammation
and vasoconstriction, inhibit monocyte chemotaxis, proliferation and migration of
smooth muscle cells, in the vascular wall and decrease the production of adhesion
molecules and metalloproteinases. PPARs gamma agonists (glitazones) have been shown
to reduce the development of atherosclerotic lesions in rats. The potential clinical
benefit of PPARs gamma agonists on the reduction of cardiovascular disease, in type
2 diabetic patients, will be specified by the ongoing intervention studies.