Pioglitazone Confers Greatest Benefit to High-Risk Patients Post-Sroke

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The researchers found that the 5-year risk for stroke or MI was 6.0% in the pioglitazone group compared with 7.9% in the placebo group.
The researchers found that the 5-year risk for stroke or MI was 6.0% in the pioglitazone group compared with 7.9% in the placebo group.

HealthDay News — For patients after an ischemic stroke or transient ischemic attack, pioglitazone is associated with greater benefit for those at higher risk for stroke or myocardial infarction (MI), according to a study published in JAMA Neurology.

Walter N. Kernan, MD, from the Yale School of Medicine in New Haven, Connecticut, and colleagues conducted a secondary analysis of a trial of pioglitazone for secondary prevention among patients with an ischemic stroke or transient ischemic attack and insulin resistance. Patients were stratified for risk of stroke or MI within 5 years; the efficacy of pioglitazone for preventing stroke or MI was calculated within each stratum.

The researchers found that the 5-year risk for stroke or MI was 6.0% in the pioglitazone group compared with 7.9% in the placebo group, among patients with lower baseline risk (absolute risk difference, −1.9%; 95% confidence interval, −4.4% to 0.6%). The risk was 14.7 and 19.6 for patients at higher risk in the pioglitazone and placebo groups, respectively (absolute risk difference, −4.9%; 95% confidence interval, −8.6% to 1.2%). Similar hazard ratios were seen for patients below or above the median risk (0.77 vs 0.75; P =.92).

"After an ischemic stroke or transient ischemic attack, patients at higher risk for stroke or MI derive a greater absolute benefit from pioglitazone compared with patients at lower risk," the authors write.

Two authors disclosed financial ties to the pharmaceutical industry.

Reference

Kernan WN, Viscoli CM, Dearborn JL, et al. Targeting pioglitazone hydrochloride therapy after stroke or transient ischemic attack according to pretreatment risk for stroke or myocardial infarction [published online September 18, 2017]. JAMA Neurol. doi: 10.1001/jamaneurol.2017.2136

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