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Thiazolidinediones (TZDs) are widely prescribed for the treatment of type 2 diabetes. They were reported to have vasculoprotective properties like a reduction in carotid artery intima-media thickness progression (1) but may also reduce bone formation and favor bone loss (2,3). The decoy receptor osteoprotegerin, a member of the receptor activator of nuclear factor-κB ligand/osteoprotegerin system, involved in osteoclast development and function (4), might also be a regulator of vascular calcification and an indicator of vascular disease (5). In diabetic patients, this latter point is supported by our previous data showing a positive association between silent myocardial ischemia (SMI) and osteoprotegerin levels (6,7). We tested, in a case-control study, the a priori hypothesis that TZDs might be associated with decreased osteoprotegerin levels and lower prevalence of SMI in patients treated with TZDs. A total of 198 consecutive asymptomatic non–insulin-treated type 2 diabetes patients (age 60.1 ± 9.1, 68% male, A1C 8.1 ± 1.7%, BMI 30.7 ± 4.6 kg/m2) with one or more additional risk factor underwent SMI screening, using dipyridamole combined with exercise myocardial perfusion imaging (MPI) as previously described (6,7). SMI was defined as positive MPI (mean activity 1 mm). The 46 type 2 diabetic patients …

Coronary artery disease (CAD) is the leading cause of mortality in people with type 1 diabetes. Silent myocardial ischemia (SMI) is common in this population (1), and a large body of evidence attests to the high diagnostic yield of stress myocardial perfusion imaging (MPI) for the prediction of major coronary events (2,3). However, screening all patients with stress MPI is not practical and should be limited to those with a high-risk profile (4). No such profile has been determined in type 1 diabetic patients. We thus evaluated the clinical and biological variables associated with silent coronary stenosis to determine a high-risk profile of asymptomatic type 1 diabetic patients who should benefit from stress MPI screening. All asymptomatic type 1 diabetic patients admitted to our department between January 1999 and June 2002 were considered for SMI screening, using dipyridamol (0.75 mg/kg) combined with exercise on an ergometer bicycle (when feasible) and stress-gated single-photon emission computed tomographic99Tcm-MIBI imaging if they had at least one of the following conditions: one other major cardiovascular risk factors, age ≥60 years, or peripheral arterial disease (PAD). Patients with known CAD, age ≥80 or

Inflammatory markers (IM) have been associated with the risk of development of coronary artery disease (CAD) in nondiabetic patients (1). So far, no data are available concerning the relationship between angiographically documented CAD and inflammation in the diabetic population. Moreover, recently it has been suggested that in patients with silent myocardial ischemia (SMI), a condition frequently observed in diabetic populations (2), there is a higher production of anti-inflammatory cytokines (3), which suggests that the commonly described association between IM and CAD might not be found in patients with SMI. Therefore, …