In a nutshell
The study examined the impact of pioglitazone (Actos) on acute coronary syndromes in patients with insulin resistance who had a recent stroke. The authors concluded that pioglitazone reduced the risk of heart attack in these patients.
Some background
Insulin resistance occurs when the body cannot use insulin normally, and sugar is not taken into the cells for energy. This can lead to high blood sugar levels. This can eventually develop into type 2 diabetes. Insulin resistance is common in patients with cardiovascular disease who do not have diabetes. Insulin resistance is associated with a higher risk of heart attack in these patients. Pioglitazone (Actos) is a therapy used to combat insulin resistance and to treat diabetes. A recent study (the IRIS trial) showed that pioglitazone resulted in a decreased risk of stroke and heart attack in patients who had had a recent stroke. The full impact of pioglitazone on these patients, however, was not described.
Methods & findings
This study aimed to describe the effects of pioglitazone on acute coronary syndromes (ACS, blocked blood supply to the heart) among the patients included in the IRIS trial. ACS includes types of heart attacks called myocardial infarctions (MI). The initial study included 3876 patients with insulin resistance, a recent stroke and without diabetes. Patients were treated with either pioglitazone or a placebo (substance with no active effect). Patients were followed for 4.8 years.
Of these patients, 225 had ACS. There were 28 ST-elevation myocardial infarction (STEMI) events, which is complete blocked blood flow to the heart. There were 98 non-ST-elevation myocardial infarction (NSTEMI) events, which is partial blocked blood flow and therefore less severe.
83 patients who were treated with pioglitazone had ACS events. 116 patients treated with placebo had ACS events. Overall, there was a 29% reduction in the risk of ACS for patients treated with pioglitazone. This was particularly specific to STEMI events.
The bottom line
The authors concluded that pioglitazone reduced the risk of acute coronary syndromes after recent stroke in patients with insulin resistance without diabetes.
Published By :
Circulation
Date :
Feb 28, 2017
