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