Diabetes drug may prevent recurring strokes

February 17, 2016, National Institutes of Health
Diabetes drug may prevent recurring strokes
Ischemic stroke occurs when a brain blood vessel gets blocked. The gray area represents brain tissue that is not receiving nutrients as a result of the stroke. Credit: NINDS.

Pioglitazone, a drug used for type 2 diabetes, may prevent recurrent stroke and heart attacks in people with insulin resistance but without diabetes. The results of the Insulin Resistance Intervention after Stroke (IRIS) trial, presented at the International Stroke Conference 2016 in Los Angeles and published in the New England Journal of Medicine, suggest a potential new method to prevent stroke and heart attack in high-risk patients who have already had one stroke or transient ischemic attack. This large, international study was supported by the National Institutes of Health's National Institute of Neurological Disorders and Stroke (NINDS).

The IRIS trial is the first study to provide evidence that a drug targeting cell metabolism may prevent secondary strokes and heart attacks even before diabetes develops. Insulin regulates metabolism and keeps blood sugar levels from getting too high, along with many other processes, in the body. Insulin resistance is a condition in which the body produces insulin but does not use it effectively.

"This study represents a novel approach to prevent recurrent vascular events by reversing a specific metabolic abnormality thought to increase the risk for future heart attack or stroke," said Walter J. Koroshetz, M.D., director of the NINDS.

"The IRIS trial supports the value of more research to test the vascular benefits of other interventions such as exercise, diet and medications that have similar effects on metabolism as ," said Walter N. Kernan, M.D. professor of general medicine at Yale University School of Medicine, New Haven, Connecticut, and lead author of the study.

More than 3000 patients from seven countries who had experienced an or transient ischemic attack within the previous six months were randomized to receive pioglitazone or placebo for up to five years in addition to standard care. Ischemic stroke and can occur when a cerebral blood vessel becomes blocked, cutting off the delivery of oxygen and nutrients to brain tissue.

In this study, stroke or heart attack occurred in 9 percent of participants taking pioglitazone and 11.8 percent of patients on placebo, which was a relative decrease of 24 percent. The results suggest that 28 strokes or heart attacks may be prevented for every 1000 patients who take pioglitazone for up to five years.

Insulin resistance is a hallmark of type 2 diabetes but also occurs in more than 50 percent of people with ischemic stroke who do not have diabetes. People with diabetes are known to have increased risk of stroke. Previous research suggested that increases risk for stroke, but the IRIS trial was the first to treat it and suggested that the therapy reduced the risk of and heart attacks. However, pioglitazone is not FDA-approved for the uses studied in the IRIS trial.

In this study, pioglitazone also reduced the risk of diabetes by 52 percent in the study participants.

The study evidenced an additional known side effect of the drug, which is an increased risk of bone fractures. To help doctors and patients choose the best strategy for preventing recurring strokes, future studies will attempt to identify a person's risk of bone fractures due to pioglitazone. As approved for use in medical practice, the drug also carries additional side effects (drug label).

"More research is needed to determine the mechanisms by which pioglitazone decreases risk for and and increases bone fracture risk, with the hope of developing strategies that maximize benefit and minimize serious side effects in our patients," said Dr. Kernan.

Explore further: Migraine with aura linked to clot-caused strokes

More information: Walter N. Kernan et al. Pioglitazone after Ischemic Stroke or Transient Ischemic Attack, New England Journal of Medicine (2016). DOI: 10.1056/NEJMoa1506930

Related Stories

Migraine with aura linked to clot-caused strokes

February 17, 2016
People who have migraines with aura are more likely to have strokes caused by either a blood clot in the heart (cardio-embolic stroke) or a clot within the brain's blood vessels (thrombotic stroke), compared to those that ...

Pregnancy in older age increases stroke, heart attack risk years later

February 17, 2016
Women who become pregnant at age 40 or older face a greater risk of stroke and heart attack later in life than women who become pregnant at a younger age, according to research presented at the American Stroke Association's ...

NHS urged to screen stroke patients for silent heart disease to prevent thousands of deaths

January 20, 2016
A new study has revealed that more than a third of stroke patients with no known history of heart disease have significant tightening of the arteries around their heart (coronary artery disease) and three percent will go ...

Diabetes discovery could lead to more effective drugs

February 3, 2016
The formation of type 2 diabetes is directly related to how our muscles convert sugar, a landmark new study has found.

When is an aspirin a day to prevent heart attacks too risky?

December 10, 2015
We've known for a long time that aspirin can help prevent damage from a heart attack or a stroke if taken during one of those events. In fact, you might have seen ads about how aspirin can be lifesaving during a heart attack.

Adults born with heart defects have a substantially higher risk of stroke

November 23, 2015
Adults with congenital heart defects have substantially higher rates of stroke compared to the general population, according to research published in the American Heart Association journal, Circulation.

Recommended for you

Bypass beats stents for diabetics with heart trouble: study

November 13, 2018
(HealthDay)—People with both diabetes and multiple clogged heart arteries live longer if they undergo bypass surgery rather than have their blood vessels reopened with stents, according to follow-up results from a landmark ...

Kawasaki disease: One disease, multiple triggers

November 12, 2018
Researchers at University of California San Diego School of Medicine, Scripps Institution of Oceanography, and international collaborators have evidence that Kawasaki Disease (KD) does not have a single cause. By studying ...

New treatment significantly reduces cardiovascular events when combined with statins

November 12, 2018
Statins are the most commonly used treatment for cardiovascular disease. Despite reducing certain risk factors, if triglyceride levels remain high with use of statins, there is still a significant risk for heart attack, stroke ...

Study: How vitamin D and fish oil affect risk of heart attack, stroke and cancer

November 12, 2018
For years, it's remained an open question: What effects do dietary supplements such as high doses of vitamin D or omega-3 fatty acids derived from fish oil have on the risk of diseases such as heart attack, stroke and cancer? ...

Diabetes drug might also ease heart failure risks

November 12, 2018
(HealthDay)—The diabetes drug Farxiga might do double-duty for patients, helping to ward off another killer, heart failure, new research shows.

Updated cholesterol guidelines offer more personalized risk assessment, additional treatment options

November 12, 2018
More personalized risk assessments and new cholesterol-lowering drug options for people at the highest risk for cardiovascular disease (CVD) are among the key recommendations in the 2018 cholesterol guidelines from the American ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.