Stroke Risk Lowered With Pioglitazone for Insulin Resistant Patients
HealthDay News — For patients with insulin resistance with recent stroke or transient ischemic attack (TIA), pioglitazone is associated with reduced risk of stroke or myocardial infarction, according to a study published online February 17 in the New England Journal of Medicine. The research was published to coincide with the annual American Stroke Association's International Stroke Conference, held from February 17 to 19 in Los Angeles.
Walter N. Kernan, MD, from Yale University in New Haven, Conn., and colleagues randomized 3876 patients with recent ischemic stroke or TIA to receive pioglitazone (target dose, 45 mg daily) or placebo. Eligible patients had insulin resistance, but did not have diabetes.
The researchers found that a primary outcome (fatal or nonfatal stroke or myocardial infarction) had occurred in 9.0 and in 11.8% of the pioglitazone and placebo groups, respectively, by 4.8 years (hazard ratio [HR], 0.76; 95 percent confidence interval [CI], 0.62 to 0.93). Diabetes developed in 3.8 and 7.7% of patients, respectively (HR, 0.48; 95% CI, 0.33 to 0.69). No significant between-group difference was seen in all-cause mortality (HR, 0.93; 95% CI, 0.73 to 1.17). Compared with placebo, pioglitazone was associated with a greater frequency of weight gain exceeding 4.5 kg, edema (both P < 0.001), and bone fracture requiring surgery or hospitalization (P = 0.003).
"We found that pioglitazone, a therapy directed at improving insulin sensitivity, can prevent cardiovascular events among patients who have insulin resistance along with cerebrovascular disease," the authors write.
Pioglitazone and placebo were provided by Takeda Pharmaceuticals.