Background Thiazolidinediones (TZDs) not only improve insulin resistance, lowering blood sugar, also has anti-atherosclerotic effect. However, whether the protective effect on cardiovascular pioglitazone is still controversial. Methods Totally 98 patients with coronary disease and diabetes mellitus were randomly divided into pioglitazone group (n = 48) receiving conventional therapy and pioglitazone (15 mg/day), and control group (n = 50) merely receiving conventional therapy. The patients were followed up for 12 months. The plasma level of Plasminogen activator Inhibitor 1 (PAI-1) and P-selectin were detected at baseline and after treatment for 12 months by ELISA, and major adverse cardiac events (MACE) were studied. Results Pioglitazone therapy for 12 months was associated with a significant decrease of PAI-1 [(7.9 ± 1.4 vs 4.2 ± 0.5)ng/mL, P < 0.05] and P-selectin[(16.6 ± 6.8 vs 12.4 ± 3.6)ng/mL, P < 0.05], MACE was significantly lower in the pioglitazone group than in the control group [acute coronary syndrome (ACS): 32.0% vs 10.4%, P < 0.05; target vessel revascularization:22.0% vs 6.3%, P < 0.05]. Conclusions Pioglitazone can effectively reduce the plasma level of PAI-1, P-selectin and the occurrence of MACE in patients with coronary heart disease and diabetes mellitus. Background Tiazolidinediones (TZDs) not only improve insulin resistance, lowering blood sugar, also has anti-atherosclerotic effect. However, whether the protective effect on cardiovascular pioglitazone is still controversial. Methods Totally 98 patients with coronary disease and diabetes mellitus were randomly divided into pioglitazone The plasma level of Plasminogen activator Inhibitor 1 (PAI (n = 48) receiving conventional therapy and pioglitazone (15 mg / day), and control group -1) and P-selectin were detected at baseline and after treatment for 12 months by ELISA, and major adverse cardiac events (MACE) were studied. Results Pioglitazone therapy for 12 months was associated with a significant decrease of PAI-1 [(7.9 P <0.05] and P-selectin [(16.6 ± 6.8 vs 12.4 ± 3.6) ng / mL, P <0.05]. MACE was significantly lower in the pioglitazone group than in the contr P <0.05) .Conclusion Pioglitazone can effectively reduce the plasma level of PAI-1 in the group of OL: 32.0% vs 10.4%, P <0.05; target vessel revascularization: 22.0% vs 6.3% selectin and the occurrence of MACE in patients with coronary heart disease and diabetes mellitus.