Pioglitazone Efficacy in Patients at High Risk of Recurrent Stroke

Patients were stratified for risk of stroke or MI within 5 years
Patients were stratified for risk of stroke or MI within 5 years

HealthDay News — For patients after an ischemic stroke or transient ischemic attack, pioglitazone is associated with greater benefit for those at higher risk for stroke or myocardial infarction (MI), according to a study published online September 18 in JAMA Neurology.

Walter N. Kernan, MD, from the Yale School of Medicine in New Haven, Connecticut, and colleagues conducted a secondary analysis of a trial of pioglitazone for secondary prevention among patients with an ischemic stroke or transient ischemic attack and insulin resistance. Patients were stratified for risk of stroke or MI within 5 years; the efficacy of pioglitazone for preventing stroke or MI was calculated within each stratum. 

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The researchers found that the five-year risk for stroke or MI was 6.0% in the pioglitazone group compared with 7.9% in the placebo group, among patients with lower baseline risk (absolute risk difference, −1.9%; 95% CI, −4.4 to 0.6%). The risk was 14.7 and 19.6 for patients at higher risk in the pioglitazone and placebo groups, respectively (absolute risk difference, −4.9%; 95% CI, −8.6 to 1.2%). Similar hazard ratios were seen for patients below or above the median risk (0.77 vs. 0.75; P=0.92).

"After an ischemic stroke or transient ischemic attack, patients at higher risk for stroke or MI derive a greater absolute benefit from pioglitazone compared with patients at lower risk," the authors write.

Two authors disclosed financial ties to the pharmaceutical industry.

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