Fluid retention versus cardio protection: rethinking pioglitazone

Pioglitazone, a thiazolidinedione, acts through peroxisome proliferator-activated receptor gamma (PPAR-gamma) and is an established insulin sensitizer used in type 2 diabetes. Many cardio-protective aspects of pioglitazone are being actively researched. The drug modulates neurohormonal pathways and improves diastolic dysfunction in hypertensive patients. In diabetic patients, pioglitazone has been shown to reduce hyperperfusion injury post-STEMI. It also exerts positive effects on cardiac and vascular remodeling. Despite its cardioprotective effects, studies have shown that weight gain and oedema are among the most serious implications of the drug, specifically limiting its role in patients with heart failure. Hence, further studies are required to demonstrate the effect of pioglitazone among patients with heart failure.