Physicians' Academy for Cardiovascular Education

TZD reduces ACS risk in insulin-resistant non-diabetic patients with prior stroke or TIA

Cardiac Outcomes After Ischemic Stroke or TIA: Effects of Pioglitazone in Patients with Insulin Resistance Without Diabetes

Literature - Young LH, Viscoli CM, Curtis JP, et al. - Circulation 2017 Feb 28, Epub ahead of print


Epidemiological research showed that insulin resistance is associated with an increased risk for both myocardial infarction (MI) and stroke [1-3]. Moreover, it has recently been reported that insulin resistance was present in 63% of patients without diabetes after a recent ischemic stroke or transient ischemic attack (TIA) [4]. It seems therefore interesting whether intervention of insulin resistance, eg. with thiazolidinediones (TZDs), reduces cardiovascular (CV) risk in patients without diabetes.

The PROactive trial showed that pioglitazone, a TZD, reduced the risk for a secondary outcome of CV mortality and non-fatal stroke by 28% in diabetes patients with a history of stroke [5]. This research was extended by the insulin resistance intervention in stroke (IRIS) trial, in which effectiveness of pioglitazone was shown in patients with insulin resistance non-diabetic patients that recently experienced a stroke or TIA [4].

As pioglitazone has been shown to harbour coronary artery anti-atherosclerotic and possibly vascular stabilizing potential, the effect of pioglitazone on the incidence of acute coronary syndrome (ACS) was studied in a secondary analysis of the IRIS study with insulin resistant non-diabetic patients (n=3876). For this analysis, insulin resistance was defined by HOMA-IR >3.0.

Main results


In this secondary analysis of the IRIS trial, pioglitazone reduced the risk of ACS, particularly the most serious events, in insulin-resistant patients without diabetes after ischemic stroke or TIA. This was most evident for spontaneous type I MI, suggesting coronary artery plaque stabilization, and pioglitazone was more effective in preventing more clinically significant MIs.


Show references

Find this article online at Circulation

Share this page with your colleagues and friends: