The Cardiovascular Effects of Peroxisome Proliferator-activated Receptor Agonists - 23/01/12
, Aaron Leong, MD a, b, , Kristian B. Filion, PhD b, Jacques Genest, MD c, Iliana C. Lega, MD a, b, Salvatore Mottillo, BSc a, b, d, Paul Poirier, MD, PhD e, Jennifer Reoch, BSc a, b, f, Mark J. Eisenberg, MD, MPH a, b, g, ⁎ 
Reprint requests should be addressed to Mark J. Eisenberg, MD, MPH, Professor of Medicine, Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital/McGill University, 3755 Côte Ste-Catherine Road, Suite H-421.1, Montreal, Quebec, Canada H3T 1E2Abstract |
Although peroxisome proliferator-activated receptor agonists are prescribed to improve cardiovascular risk factors, their cardiovascular safety is controversial. We therefore reviewed the literature to identify landmark randomized controlled trials evaluating the effect of peroxisome proliferator-activated receptor gamma agonists (pioglitazone and rosiglitazone), alpha agonists (fenofibrate and gemfibrozil), and pan agonists (bezafibrate, muraglitazar, ragaglitazar, tesaglitazar, and aleglitazar) on cardiovascular outcomes. Pioglitazone may modestly reduce cardiovascular events but also may increase the risk of bladder cancer. Rosiglitazone increases the risk of myocardial infarction and has been withdrawn in European and restricted in the United States. Fibrates improve cardiovascular outcomes only in select subgroups: fenofibrate in diabetic patients with metabolic syndrome, gemfibrozil in patients with dyslipidemia, and bezafibrate in patients with diabetes or metabolic syndrome. The cardiovascular safety of the new pan agonist aleglitazar, currently in phase II trials, remains to be determined. The heterogenous effects of peroxisome proliferator-activated receptor agonists to date highlight the importance of postmarketing surveillance. The critical question of why peroxisome proliferator-activated receptor agonists seem to improve cardiovascular risk factors without significantly improving cardiovascular outcomes requires further investigation.
Le texte complet de cet article est disponible en PDF.Keywords : Aleglitazar, Bezafibrate, Cardiovascular outcomes, Cardiovascular risk factors, Fenofibrate, Fibrates, Gemfibrozil, Pan agonists, Peroxisome proliferator-activated receptor agonists, Pioglitazone, Review, Rosiglitazone, Thiazolidinediones
Plan
| Funding: Dr Joseph is a Chercheur-National of the Fonds de la Recherche en Santé du Québec (FRSQ). Dr Poirier is a Senior Physician-Scientist of the FRSQ. Dr Schiffrin holds a Canada Research Chair in Vascular and Hypertension Research. Dr Eisenberg is a Chercheur-National of the FRSQ. |
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| Conflict of Interest: Dr Genest is on the speaker's bureau for Merck and Astra Zeneca. No other authors have conflicts of interest. |
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| Authorship: All authors had access to the data and played a role in writing this manuscript. |
Vol 125 - N° 2
P. 126-133 - février 2012 Retour au numéro
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