New front opens in battle against stroke – Medicinal approach cuts recurrence risk by 24 percent in stroke patients

Medical scientists discovered that an already-known drug showed to reduce the risk of stroke or heart attack by almost a quarter in patients who had previously suffered a stroke or mini-stroke!  The drug is pioglitazone, which some of you know is used to treat diabetes.  Pioglitazone works by making the body less insulin resistant, and researchers found that insulin resistance puts you at a risk for heart attack and stroke.

The typical drugs to treat stroke are blood thinners and anticoagulants.  Statins and blood pressure medications may also help in some cases.  It is unusual for a diabetes drug to be used to treat heart attack or stroke.

Blood thinners, statins, and blood pressure management medications have all been shown to significantly reduce the risk for stroke.  However, researchers wanted to explore another risk factor:  insulin resistance, also called “pre diabetes.”

Researchers showed that insulin resistance was associated with a higher risk of stroke and heart attack.  Therefore, they tested pioglitazone, a diabetes drug that can help reduce insulin resistance.

The results of the five-year, double-blind trial of pioglitazone versus a placebo, was that the team found that patients receiving the drug had 24% fewer incidents of either stroke or heart attack.  This is important because pioglitazone may now be used to prevent diabetes as well as heart attack / stroke.

My question is:  Knowing the side effects of pioglitazone, would you been willing to reccommend this medication as a preventative measure? For example, if the patient has a family history of heart attack / stroke, but has not had one?  Do you think the side effects outweigh the benefit of taking the drug as a preventative measure?

 

 

Walter N. Kernan, Catherine M. Viscoli, Karen L. Furie, Lawrence H. Young, Silvio E. Inzucchi, Mark Gorman, Peter D. Guarino, Anne M. Lovejoy, Peter N. Peduzzi, Robin Conwit, Lawrence M. Brass, Gregory G. Schwartz, Harold P. Adams, Leo Berger, Antonio Carolei, Wayne Clark, Bruce Coull, Gary A. Ford, Dawn Kleindorfer, John R. O’Leary, Mark W. Parsons, Peter Ringleb, Souvik Sen, J. David Spence, David Tanne, David Wang, Toni R. Winder. Pioglitazone after Ischemic Stroke or Transient Ischemic Attack. New England Journal of Medicine, 2016; 160217112012002 DOI: 10.1056/NEJMoa1506930

Diabetes drug shown to help body rebuild after heart attack

Since heart disease is the leading cause of illness in diabetic patients, researchers have decided to explore the effects that a diabetes drug, metformin, has on the heart.

The study was funded by the Diabetes Research and Wellness Foundation, Queen Elizabeth Hospital Diabetes Charity, Newcastle University and King Abdulaziz University.

Researchers used stem cells from the umbilical cord to construct a model simulating a heart attack in a lab.  They found three discoveries:

  1. New blood vessel formation is essential to heart attack recovery, and that metformin helps new blood vessels to form.
  2. The research also shows that during a heart attack, there is a lack of oxygen in the presence of high glucose levels, and metformin reverses that process.
  3. It was also found that metformin affects several genes that are important in the growth of new blood vessels.

Since not all diabetic patients can take metformin, it is hopeful that this discovery will lead to research and development of new drugs, since there is a better understanding of how metformin works.  There is also demand for improved treatment for diabetic patients so that they may survive a heart attack.

This study is significant because the research can instantly make a difference in treatments by offering a new approach to heart disease in diabetic patients.  The study is also the first report describing the effect of the physiological concentration of metformin as seen in patients.

Going forward, it is hopeful that clinical trials will be started to further investigate metformin’s effect on heart attack recovery in patients.

The question I will pose is: Since biguanides work in similar ways, do you think that other biguanides will help in heart attack recovery?

 

Sherin Bakhashab, Fahad W. Ahmed, Hans-Juergen Schulten, Ayat Bashir, Sajjad Karim, Abdulrahman L. Al-Malki, Mamdooh A. Gari, Adel M. Abuzenadah, Adeel G. Chaudhary, Mohammed H. Alqahtani, Sahira Lary, Farid Ahmed, Jolanta U. Weaver. Metformin improves the angiogenic potential of human CD34 cells co-incident with downregulating CXCL10 and TIMP1 gene expression and increasing VEGFA under hyperglycemia and hypoxia within a therapeutic window for myocardial infarction. Cardiovascular Diabetology, 2016; 15 (1) DOI:10.1186/s12933-016-0344-2