Targeting Pioglitazone Hydrochloride Therapy After Stroke or Transient Ischemic Attack According to Pretreatment Risk for Stroke or Myocardial Infarction
View abstract on PubMed
Summary
This summary is machine-generated.Pioglitazone offers greater absolute benefit in preventing stroke or myocardial infarction (MI) for high-risk patients post-ischemic event. However, higher fracture risk is associated with this treatment.
Area Of Science
- Neurology
- Cardiology
- Pharmacology
Background
- Individual patient responses to therapy vary, meaning average treatment effects may not apply universally.
- Insulin resistance is a significant factor in patients following ischemic stroke or transient ischemic attack (TIA).
Purpose Of The Study
- To assess if patients with ischemic stroke/TIA and insulin resistance at higher risk for subsequent stroke or myocardial infarction (MI) gain more benefit from pioglitazone hydrochloride compared to lower-risk patients.
- Investigate the differential efficacy of pioglitazone based on baseline cardiovascular risk in secondary prevention.
Main Methods
- Secondary analysis of the Insulin Resistance Intervention After Stroke trial (NCT00091949), a double-blind, placebo-controlled study.
- Patients with ischemic stroke/TIA and insulin resistance (without diabetes) were stratified by 5-year risk for stroke/MI using a Cox regression model.
- Efficacy of pioglitazone vs. placebo in preventing stroke/MI was calculated within risk strata. Safety outcomes included death, heart failure, weight gain, and fracture.
Main Results
- Among 3876 participants, pioglitazone showed a greater absolute risk reduction for stroke/MI in higher-risk patients (-4.9%) compared to lower-risk patients (-1.9%).
- Hazard ratios for stroke/MI were similar across risk strata (0.77 vs. 0.75), indicating consistent relative risk reduction.
- Pioglitazone was associated with less weight gain but a higher risk of fracture in higher-risk individuals.
Conclusions
- Patients with ischemic stroke/TIA and insulin resistance at higher risk for future stroke/MI derive greater absolute benefit from pioglitazone.
- The increased benefit must be weighed against a higher risk of bone fracture associated with pioglitazone in these patients.