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.