Pioglitazone for Stroke Prevention: An Addition to Our Toolbox?

A randomized trial suggests a stroke benefit, but also some adverse effects, after a cerebrovascular event in patients with insulin resistance.

Insulin resistance is quite frequent in stroke patients, even those without overt diabetes mellitus (DM). In this trial, researchers investigated use of the insulin-sensitizing drug pioglitazone in 3876 patients with ischemic stroke or transient ischemic attack (TIA) in the previous 6 months and insulin resistance, defined as a HOMA-IR value >3.0 (fasting glucose [mmol/L] × fasting insulin [microunits/mL], divided by 22.5). Patients with established DM or advanced heart failure were excluded. Participants were randomized to pioglitazone (target dose, 45 mg daily) or placebo. The primary endpoint was stroke or myocardial infarction (MI).

During a median follow-up period of 4.8 years, the pioglitazone group had a significantly lower rate of th…

Reviewing Author

Seemant Chaturvedi, MD

Disclosures

Consultant/Advisory BoardBayer Pharmaceuticals; Novartis

Grant/Research SupportNational Institute of Neurological Disorders and Stroke

Editorial BoardsNeurology; Stroke

Seemant Chaturvedi, MD

Disclosures

Consultant/Advisory BoardBayer Pharmaceuticals; Novartis

Grant/Research SupportNational Institute of Neurological Disorders and Stroke

Editorial BoardsNeurology; Stroke

Pioglitazone for Stroke Prevention: An Addition to Our Toolbox?

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Reviewing Author