Results of a federally funded study have uncovered a possible new use for the diabetes drug pioglitazone.
Researchers found the drug, formerly marketed under the brand name Actos, may lower the risk of heart attacks and recurrent strokes in patients who have survived a first stroke and have developed a resistance to the pioglitazone hormone.
Findings of the study were presented at the American Heart Association's recent International Stroke Conference.
Experts hope the discovery will prompt more neurologists to screen stroke survivors for insulin resistance.
“This is the very beginning of our exploration of insulin resistance as a target for vascular prevention,” Dr. Walter Kernan, the study’s lead researcher and a professor at Yale University School of Medicine, said. “We’re at the very beginning of what I hope will be a scientific advance.”
Detractors said side effects of pioglitazone -- including bone fractures -- could outweigh potential benefits.
The Insulin Resistance Intervention after Stroke (IRIS) study used 3,876 patients who had had a stroke or transient ischemic attack, or warning stroke, as subjects.
Five years post-event, patients treated with pioglitazone were shown to have a 24 percent drop in risk of having another stroke, while the risk fell just 11.8 percent for subjects treated with placebo.
"This is one of the under-told stories of cardiovascular disease – how frequent insulin resistance is a risk factor,” Dr. Silvio Inzucchi, an endocrinologist, director of the Yale Diabetes Center and a co-investigator on the trial, said. “That makes the results even more impressive, that this reduction was on top of current standard therapies.”
Pioglitazone treatment used to be common. It dropped drastically after studies blamed the therapy for an increased risk of bladder cancer and heart failure. Later research showed that the drug was not the cause, however.
“That set the field back 10 years,” Inzucchi said. “But these new findings might encourage the pharmaceutical industry to rethink the notion of insulin sensitizers as vasculoprotective, and to develop better and safer drugs... ."
Presently, insulin levels are currently not checked when patients are subjected to a standard series of medical tests. Pioglitazone does carry a risk of side effects, including bone fractures and weight gain.
“It seems like this all comes at a cost,” Dr. Kyra Becker, director of vascular neurology services at the University of Washington Comprehensive Stroke Center at Harborview Medical Center, said. “They showed you can prevent three strokes or heart attacks in every 100 patients treated, but two of those 100 will have a serious bone fracture. A lot of society would rather take a drug than go to the gym or walk around their neighborhood. But we need to keep pushing people to change their behaviors.”
Diabetes drug may reduce stroke risk
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