Kernan WN, Viscoli CM, Furie KL et al. Pioglitazone after ischemic stroke or transient ischemic attack. NEJM 2016; 374:1321-31 and editorial Semenkovich CF. Insulin resistance and along, strange trip. NEJM; 2016: 374:14-15.
Study shows that the drug pioglitozone for secondary prevention in stroke/TIA is effective. N=3876 pts v. placebo, patients with no history of diabetes but with insulin resistance, who were given drug had less diabetes develop, more weight gain, edema and fracture, and less MI/CVA at mean 4.8 years. Effect magnitude was fairly small, with primary outcome in 9.0 percent (175 patients) in active drug group and 11.8 % (228 patients) in placebo group. Patients on pioglitazone were more likely than placebo patients to stop drug due to side effects.
This is also known as the IRIS trial (insulin resistance after stroke).
Editorial speculates patient selection is important to avoid side effects and profiling should include PPAR-y genes.
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