DOC News May 1, 2007
Volume 4 Number 5 p. 14
© 2007 American Diabetes Association
Recurrent Stroke Risk Reduced With Pioglitazone
Patients with type 2 diabetes who take pioglitazone could significantly
reduce the risk of a recurrent stroke, according to a recent United Kingdom
study. Patients with type 2 diabetes are at increased risk of cerebrovascular
disease and at higher risk of recurrent ischemic stroke. But new research in
which the addition of pioglitazone to existing medications for dyslipidemia,
hypertension, and hyperglycemia was compared with placebo showed the addition
of pioglitazone can reduce a recurrent fatal or nonfatal stroke by 85%.
Participants with no previous history of stroke showed no benefit with
pioglitazone, however.
Researchers studied 5,238 patients with type 2 diabetes who had enrolled in
the Prospective Pioglitazone Clinical Trial in Macrovascular Events
(PROactive) with or without a history of stroke. Participants 35–75
years were followed for 34.5 months. Patients who enrolled in the study with a
previous stroke >6 months prior to complementing existing cardiovascular
medications experienced a greater benefit (47%) of reducing the risk of a
recurrent or nonfatal stroke once pioglitazone was
started.
The data are similar to those obtained in a PROactive subgroup of patients
with type 2 diabetes and a previous myocardial infarction (MI). In that
subset, patients taking pioglitazone had a reduced risk of recurrent MI.
Further study is needed in prospective trials, such as the National
Institutes of Health's Insulin Resistance Intervention After Stroke trial,
which will use pioglitazone to target insulin resistance as an alternative
treatment to prevent recurrent stroke and heart attack, the researchers
conclude.
Wilcox R, Bousser M, Betteridge J, et al.: Effects of
pioglitazone in patients with type 2 diabetes with or without previous stroke:
Results from PROactive (PROspective pioglitAzone Clinical Trial In
macroVascular Events 04). Stroke 38: 865–873, 2007.[Abstract/Free Full Text]
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