The aim of the present study was to determine whether the antidiabetic agent pioglitazone has a direct inhibiting effect on myocardial hypertrophy induced by high glucose and insulin in primary cultured neonatal rat cardiomyocytes. Culture preparations of ventricular muscle cells newborn rats were utilized. At 72 h of culture age, the cardiomyocytes were incubated for another 48 h with 25.5 mmol/L glucose plus 0.1 micromol/L insulin (group 2), 25.5 mmol/L glucose and 0.1 micromol/L insulin plus 10 micromol/L pioglitazone (group 3), 10 micromol norepinephrine (group 4), respectively. Cells cultured continuously in medium served as control (group 1). Cellular surface area, protein content, atrial natriuretic factor (ANF) mRNA, and cardiotrophin-1 (CT-1) mRNA were assessed after treatment with different agents. All those parameters increased significantly after treatment with high glucose and insulin as compared with control (P < 0.01). These effects were inhibited markedly by pioglitazone. The cellular surface area and ANF mRNA in group 3 were decreased as compared with group 2 (P < 0.01). The protein content and CT-1 mRNA in group 3 were also decreased as compared with group 2 (P < 0.05). We concluded that a the cellular level myocardial hypertrophy induced by high glucose and insulin was inhibited directly by pioglitazone in primary cultured cardiac myocytes. CT-1 may be involved in myocardial hypertrophy induced by high glucose andinsulin and inhibiting effects of pioglitazone on myocardial hypertrophy.