INTRODUCTION: Type 2 diabetes mellitus is one of the most important cardiovascular risk factors. Insulin-resistance represents the common mechanism that leads to type 2 diabetes in obese subjects. Pioglitazone is an insulin-sensitizing agent available for treatment of type 2 diabetes. Large clinical trials have demonstrated the effectiveness of pioglitazone in achieving metabolic control and reducing cardiovascular morbidity and mortality. AIM: The purpose of this article is to review the effectiveness and tolerability of pioglitazone in the prevention and management of atherosclerosis in patients with type 2 diabetes. EVIDENCE REVIEW: We reviewed the main monotherapy and comparative studies of pioglitazone, and particularly the recent evidence in the field of atherosclerosis and cardiovascular prevention. PLACE IN THERAPY: The current evidence shows that pioglitazone is an effective option in the treatment of type 2 diabetes. More studies are needed to establish a role for pioglitazone in atherosclerosis prevention beyond glycemic control
