The PROactive trial (PROspective pioglitAzone Clinical Trial In macroVascular Events): what does it mean for primary care physicians?

Patients with type 2 diabetes mellitus (T2DM) are at high risk for cardiovascular disease (CVD). This complication accounts for much of the increased morbidity, mortality and costs of care associated with diabetes. Hypertension, dyslipidaemia, a pro-inflammatory phenotype, abnormal fibrinolysis and platelet activation, insulin resistance and high blood glucose concentrations all contribute to the increased risk of macrovascular disease in diabetes. Although reducing low-density lipoprotein (LDL)-cholesterol, controlling blood pressure, angiotensin-converting enzyme (ACE) inhibitors and aspirin have been shown to decrease CVD in diabetes, it is less clear that lowering glucose levels decreases risk. The PROactive trial was undertaken to test whether treatment with the thiazolidinedione pioglitazone could decrease the number of CVD events in high-risk patients with T2DM.