High-Risk Stroke Patients See Greater Benefit From Pioglitazone
Insulin-resistant stroke patients who have a high risk of recurrent stroke or myocardial infarction (MI) see greater benefits from pioglitazone than those with lower risk, according to a recent study.
Previous research has suggested that the insulin sensitizer pioglitazone hydrochloride, when added to standard secondary prevention therapies, could help to reduce the risk for stroke or MI in patients who experience an ischemic stroke or transient ischemic attack (TIA). However, pioglitazone is associated with weight gain, peripheral edema, and higher risk of fracture.
__________________________________________________________________________
Ischemic Stroke as a Consequence of Granulomatosis With Polyangiitis
__________________________________________________________________________
In order to estimate the relative and absolute effectiveness of pioglitazone following ischemic stroke or TIA among subgroups of patients categorized by risk of stroke or MI, the researchers conducted a secondary analysis of the Insulin Resistance Intervention After Stroke trial, which tested pioglitazone as secondary prevention. Eligible patients had experience an ischemic stroke or TIA within 180 days of entry and insulin resistance without diabetes.
Overall, the 5-year risk for stroke or MI among patients with the lowest baseline risk was 6% in the pioglitazone group compared with 7.9% in the placebo group. Among those with the highest risk, the risk was 14.7% in the pioglitazone group and 19.6% in the placebo group. Those patients with the highest risk saw less weight gain with pioglitazone but increased risk of fracture, compared with those at lower risk.
“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. However, the risk for fracture is also higher.”
—Michael Potts
Reference:
Kernan WN, Viscoli CM, Dearborn JL, et al. Targeting pioglitazone hydrochloride therapy after stroke or transient ischemic attack according to pretreatment risk for stroke or myocardial infarction [published online September 18, 2017]. JAMA Neurol. doi:10.1001/jamaneurol.2017.213.