Pioglitazone for Secondary Prevention in Vascular Disease? — Physician’s First Watch
Pioglitazone for Secondary Prevention in Vascular Disease?
By Joe Elia
Edited by Jaye Elizabeth Hefner, MD
Pioglitazone, which lowers insulin resistance, may help in the secondary prevention of vascular events, suggests a study presented at the International Stroke Conference and published in the New England Journal of Medicine.
Some 3900 patients with insulin resistance (but not diabetes) and a recent history of ischemic stroke or transient ischemic attack were randomized to daily pioglitazone or placebo in an international trial.
After a median follow-up of almost 5 years, the pioglitazone group had a lower incidence of stroke or myocardial infarction (9.0% vs. 11.8%) — the trial's primary outcome. The incidence of diabetes (a secondary outcome) was also lower with pioglitazone; however, weight gain exceeding 10 pounds (4.5 kg), edema, and serious fractures were all more common with the drug.
The authors speculate that pioglitazone's action on metabolic processes, endothelial function, and inflammation may be behind its salutary effect. An editorialist cautions against a "rush" to the drug, saying that "many caveats remain."