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Efficacy of Lower Doses of Pioglitazone after Stroke or Transient Ischemic Attack In Patients with Insulin Resistance
CONCLUSIONS: Lower doses of pioglitazone appear to confer much of the benefit with less adverse effects than the full dose. Further study is needed to confirm these findings so that clinicians may optimize dosing of this secondary prevention strategy in stroke patients. This article is protected by copyright. All rights reserved.PMID:35253334 | DOI:10.1111/dom.14687
Source: Atherosclerosis - March 7, 2022 Category: Cardiology Authors: J David Spence Catherine Viscoli Walter N Kernan Lawrence H Young Karen Furie Ralph DeFronzo Muhammad Abdul-Ghani Paresh Dandona Silvio E Inzucchi Source Type: research

Cardiovascular Protection with Anti-hyperglycemic Agents
AbstractDiabetes mellitus is a major risk factor for cardiovascular (CV) disease. Conversely, CV disease is responsible for a majority of the deaths in patients with diabetes. Many drug trials have concentrated on blood glucose (hemoglobin A1c) reduction. This strategy, while reducing microvascular outcomes like nephropathy and neuropathy, has little or no effect on reducing macrovascular events like heart attack, stroke, and heart failure. It has been postulated that hypoglycemia may counterbalance some of the beneficial effects of anti-hyperglycemic agents, but this is not proven. Further, trial evidence for thiazolidine...
Source: American Journal of Cardiovascular Drugs - February 15, 2019 Category: Cardiology Source Type: research

Heart Failure After Ischemic Stroke or TIA in Insulin-Resistant Patients Without Diabetes Treated with Pioglitazone.
Conclusions -In IRIS, with surveillance and dose adjustments, pioglitazone did not increase risk of HF, and conferred net cardiovascular benefit in patients with insulin resistance and cerebrovascular disease. The risk of HF with pioglitazone was not modified by baseline HF risk. The IRIS experience may be instructive for maximizing the net benefit of this therapy. Clinical Trial Registration -URL: www.clinicaltrials.gov Unique identifier: NCT00091949. PMID: 29934374 [PubMed - as supplied by publisher]
Source: Circulation - June 22, 2018 Category: Cardiology Authors: Young LH, Viscoli CM, Schwartz GG, Inzucchi SE, Curtis JP, Gorman MJ, Furie KL, Conwit R, Spatz E, Lovejoy A, Abbott JD, Jacoby DL, Kolansky DM, Ling FS, Pfau SE, Kernan WN, IRIS Investigators Tags: Circulation Source Type: research

Cardiovascular and Renal Outcomes of Newer Anti-Diabetic Medications in High-Risk Patients
AbstractPurpose of ReviewWe review the cardiovascular and renal outcomes and safety of newer anti-diabetic medications in high-risk patients. We examine the outcomes of the IRIS, EMPA-REG OUTCOME, CANVAS, LEADER, SAVOR-TIMI 53, and EXAMINE trials demonstrating the cardiovascular and renal benefits of thiazolidinediones, SGLT2 inhibitors, GLP-1 agonists, and DPP-4 inhibitors.Recent FindingsDiabetes mellitus is a leading risk factor for cardiovascular disease with rising prevalence and disease burden. The microvascular and macrovascular complications of diabetes are well-recognized and include increased risk of cardiovascula...
Source: Current Cardiology Reports - June 21, 2018 Category: Cardiology Source Type: research

Pioglitazone Prevents Stroke in Patients with a Recent TIA or Ischemic Stroke: A Planned Secondary Analysis of the IRIS Trial.
Conclusions -Pioglitazone was effective for secondary prevention of ischemic stroke in non-diabetic patients with insulin resistance. Clinical Trial Registration -URL: http://www.clinicaltrials.gov. Unique identifier: NCT00091949. PMID: 29084736 [PubMed - as supplied by publisher]
Source: Circulation - October 30, 2017 Category: Cardiology Authors: Yaghi S, Furie KL, Viscoli CM, Kamel H, Gorman M, Dearborn J, Young LH, Inzucchi SE, Lovejoy AM, Kasner SE, Conwit R, Kernan WN, IRIS Trial Investigators Tags: Circulation Source Type: research

Cardiac Outcomes After Ischemic Stroke or TIA: Effects of Pioglitazone in Patients with Insulin Resistance Without Diabetes.
Conclusions -Among patients with insulin resistance without diabetes, pioglitazone reduced the risk for acute coronary syndromes after a recent cerebrovascular event. Pioglitazone appeared to have its most prominent effect in preventing spontaneous type 1 MI's. Clinical Trial Registration - https://clinicaltrials.gov Unique Identifier: NCT00091949 US Food & Drug Administration IND: 64,622; EudraCT#2008-005546-23. PMID: 28246237 [PubMed - as supplied by publisher]
Source: Circulation - February 27, 2017 Category: Cardiology Authors: Young LH, Viscoli CM, Curtis JP, Inzucchi SE, Schwartz GG, Lovejoy AM, Furie KL, Gorman MJ, Conwit RA, Abbott JD, Jacoby DL, Kolansky DM, Pfau SE, Ling FS, Kernan WN, IRIS Investigators Tags: Circulation Source Type: research

Cerebrovascular disease: Pioglitazone reduces risk of stroke or MI
Nature Reviews Cardiology 13, 182 (2016). doi:10.1038/nrcardio.2016.34 Author: Karina Huynh Insulin resistance is present in >50% of patients without diabetes who have had an ischaemic stroke or a transient ischaemic attack (TIA). The IRIS trial investigators hypothesized that pioglitazone, an insulin-sensitizing agent, could reduce rates of stroke and myocardial infarction (MI) after ischaemic stroke or
Source: Nature Reviews Cardiology - March 3, 2016 Category: Cardiology Authors: Karina Huynh Tags: Research Highlight Source Type: research

Pioglitazone for secondary prevention after ischemic stroke and transient ischemic attack: Rationale and design of the Insulin Resistance Intervention after Stroke Trial
Publication date: December 2014 Source:American Heart Journal, Volume 168, Issue 6 Author(s): Catherine M. Viscoli , Lawrence M. Brass , Antonio Carolei , Robin Conwit , Gary A. Ford , Karen L. Furie , Mark Gorman , Peter D. Guarino , Silvio E. Inzucchi , Anne M. Lovejoy , Mark W. Parsons , Peter N. Peduzzi , Peter A. Ringleb , Gregory G. Schwartz , J. David Spence , David Tanne , Lawrence H. Young , Walter N. Kernan Background Recurrent vascular events remain a major source of morbidity and mortality after stroke or transient ischemic attack (TIA). The IRIS Trial is evaluating an approach to secondary prevention based o...
Source: American Heart Journal - November 25, 2014 Category: Cardiology Source Type: research

Rationale, design, and organization of a randomized, controlled Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS) in patients with type 2 diabetes and established cardiovascular disease
Sitagliptin, an oral dipeptidyl peptidase-4 inhibitor, lowers blood glucose when administered as monotherapy or in combination with other antihyperglycemic agents. TECOS will evaluate the effects of adding sitagliptin to usual diabetes care on cardiovascular outcomes and clinical safety. TECOS is a pragmatic, academically run, multinational, randomized, double-blind, placebo-controlled, event-driven trial recruiting approximately 14,000 patients in 38 countries who have type 2 diabetes (T2DM), are at least 50 years old, have cardiovascular disease, and have an hemoglobin A1c value between 6.5% and 8.0%. Eligible participan...
Source: American Heart Journal - October 25, 2013 Category: Cardiology Authors: Jennifer B. Green, M. Angelyn Bethel, Sanjoy K. Paul, Arne Ring, Keith D. Kaufman, Deborah R. Shapiro, Robert M. Califf, Rury R. Holman Tags: Trial Design Source Type: research