Therapy
The diabetes drug pioglitazone significantly lowers Lp(a), meta-analysis of 254 patients across 7 studies finds (Curr Atheroscler Rep 2025)
Original title: Effects of Pioglitazone On Lipoprotein(a): A Meta-analysis
This meta-analysis pooled 7 studies (4 randomised controlled trials and 3 non-randomised studies, 254 patients total) evaluating the effect of pioglitazone, a thiazolidinedione antihyperglycaemic drug known to improve insulin sensitivity and the overall lipid profile, on circulating Lp(a). Following a comprehensive search of PubMed, Scopus, Embase and Web of Science through March 2025, treatment with pioglitazone was associated with a significant decrease in circulating Lp(a) (standardised mean difference -0.373, 95% CI -0.642 to -0.104, P = 0.007), an effect that remained robust in leave-one-out sensitivity analysis. The authors suggest this incidental Lp(a)-lowering effect of an already-approved diabetes drug might offer additional atherosclerotic cardiovascular disease benefit in high-risk patients, alongside its established glycaemic and lipid effects, though this repurposing hypothesis awaits dedicated outcome trials.
Original abstract
Purpose Of Review: To evaluate the effect of pioglitazone, a member of the thiazolidinedione family of drugs known for its antihyperglycemic properties, on lipoprotein (a) [Lp(a)]. Pioglitazone is recognized for enhancing insulin sensitivity and β-cell function, and it also has a positive influence on the overall lipid profile.
Recent Findings: Meta-analysis of 7 studies (4 RCTs and three non-RCTs) including 254 patients showed a significant decrease of circulating Lp(a) levels after treatment with pioglitazone (SMD: -0.373, 95% CI: -0.642, -0.104, p = 0.007). The reduction in circulating Lp(a) was robust in the leave-one-out sensitivity analysis. The presented results were obtained following a comprehensive literature search conducted in PubMed, Scopus, Embase, and Web of Science, covering studies from their inception up to March 1, 2025. Pioglitazone significantly decreases circulating Lp(a) concentrations. This decrease might have a beneficial effect on atherosclerotic cardiovascular disease (ASCVD) in high-risk patients.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.