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ASA: Pioglitazone After Stroke, TIA Helpful in Insulin Resistance

Linked to reduction in risk of stroke, myocardial infarction in patients with insulin resistance

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WEDNESDAY, Feb. 17, 2016 (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 Feb. 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 Feb. 17 to 19 in Los Angeles.

Walter N. Kernan, M.D., from Yale University in New Haven, Conn., and colleagues randomized 3,876 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 percent 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 percent of patients, respectively (HR, 0.48; 95 percent CI, 0.33 to 0.69). No significant between-group difference was seen in all-cause mortality (HR, 0.93; 95 percent 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.

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