Meng Lee1, Jeffrey L Saver1, Hung-Wei Liao1, Chun-Hsien Lin1, Bruce Ovbiagele2. 1. From the Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan (M.L., C.-H.L.); Stroke Center, Geffen School of Medicine, University of California, Los Angeles (J.L.S.); Jia-Yi Clinic, Taoyuan, Taiwan (H.-W.L.); and Department of Neurology, Medical University of South Carolina, Charleston (B.O.). 2. From the Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan (M.L., C.-H.L.); Stroke Center, Geffen School of Medicine, University of California, Los Angeles (J.L.S.); Jia-Yi Clinic, Taoyuan, Taiwan (H.-W.L.); and Department of Neurology, Medical University of South Carolina, Charleston (B.O.). ovibes@musc.edu.
Abstract
BACKGROUND AND PURPOSE: Pioglitazone reduced major vascular events after ischemic stroke in a recent randomized controlled trial. The purpose of this study was to conduct a meta-analysis of randomized controlled trials to evaluate the effect of pioglitazone therapy in reducing the risk of recurrent stroke in stroke patients. METHODS: Pubmed, EMBASE, Medline, and Cochrane Central Register of Controlled Trials from 1966 to March 2016 were searched to identify relevant studies. We included randomized controlled trials that included comparison of pioglitazone versus control and trials in which quantitative estimates of the hazard ratio and 95% confidence interval for recurrent stroke associated with pioglitazone therapy among stroke patients were reported. Hazard ratios with 95% confidence intervals were used as a measure of the association between use of pioglitazone and risks of recurrent stroke (ischemic and hemorrhagic) and major vascular events (nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death) after pooling data across trials. Between-study heterogeneity was assessed using the I2 statistic. RESULTS: Three randomized controlled trials with 4980 participants were identified. Use of pioglitazone in stroke patients with insulin resistance, prediabetes, and diabetes mellitus was associated with lower risk of recurrent stroke (hazard ratio 0.68; 95% confidence interval, 0.50-0.92; P=0.01) and future major vascular events (hazard ratio 0.75; 95% confidence interval, 0.64-0.87; P=0.0001). There was no heterogeneity across trials. There was no evidence of an effect on all-cause mortality and heart failure. CONCLUSIONS: Pioglitazone reduces recurrent stroke and major vascular events in ischemic stroke patients with insulin resistance, prediabetes, and diabetes mellitus.
BACKGROUND AND PURPOSE:Pioglitazone reduced major vascular events after ischemic stroke in a recent randomized controlled trial. The purpose of this study was to conduct a meta-analysis of randomized controlled trials to evaluate the effect of pioglitazone therapy in reducing the risk of recurrent stroke in strokepatients. METHODS: Pubmed, EMBASE, Medline, and Cochrane Central Register of Controlled Trials from 1966 to March 2016 were searched to identify relevant studies. We included randomized controlled trials that included comparison of pioglitazone versus control and trials in which quantitative estimates of the hazard ratio and 95% confidence interval for recurrent stroke associated with pioglitazone therapy among strokepatients were reported. Hazard ratios with 95% confidence intervals were used as a measure of the association between use of pioglitazone and risks of recurrent stroke (ischemic and hemorrhagic) and major vascular events (nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death) after pooling data across trials. Between-study heterogeneity was assessed using the I2 statistic. RESULTS: Three randomized controlled trials with 4980 participants were identified. Use of pioglitazone in strokepatients with insulin resistance, prediabetes, and diabetes mellitus was associated with lower risk of recurrent stroke (hazard ratio 0.68; 95% confidence interval, 0.50-0.92; P=0.01) and future major vascular events (hazard ratio 0.75; 95% confidence interval, 0.64-0.87; P=0.0001). There was no heterogeneity across trials. There was no evidence of an effect on all-cause mortality and heart failure. CONCLUSIONS:Pioglitazone reduces recurrent stroke and major vascular events in ischemic strokepatients with insulin resistance, prediabetes, and diabetes mellitus.
Authors: J David Spence; Catherine M Viscoli; Silvio E Inzucchi; Jennifer Dearborn-Tomazos; Gary A Ford; Mark Gorman; Karen L Furie; Anne M Lovejoy; Lawrence H Young; Walter N Kernan Journal: JAMA Neurol Date: 2019-05-01 Impact factor: 18.302
Authors: Sven Francque; Gyongyi Szabo; Manal F Abdelmalek; Christopher D Byrne; Kenneth Cusi; Jean-François Dufour; Michael Roden; Frank Sacks; Frank Tacke Journal: Nat Rev Gastroenterol Hepatol Date: 2020-10-22 Impact factor: 46.802