The Type 2 diabetes drug Actos (generic name pioglitazone) may reduce the risk of a second stroke, according to a new study out of Yale School of Medicine. Cardiovascular disease, which can lead to heart attack or stroke, is the leading cause of death in people with diabetes and is responsible for one in every four deaths in the United States.
Actos, a member of the drug class known as thiazolidinediones, is a once-daily oral medicine that works by lowering insulin resistance (a condition in which the body requires extra insulin to maintain normal blood sugar levels). Previous research has indicated that insulin resistance is a risk factor for stroke and heart attack. To determine whether Actos can help protect people who have already had a stroke from further cardiovascular events, the researchers randomly assigned 3,876 people who had recently had a stroke or mini-stroke to take either 45 milligrams of Actos or placebo (inactive treatment) daily. The participants, who did not have diabetes but who did have insulin resistance, were already receiving standard post-stroke treatments, such as blood thinners and blood pressure and cholesterol medicines.
After nearly five years of follow-up, the investigators found that people taking Actos had a 24% reduced risk of another stroke compared to people taking placebo, with 9% of those on Actos having a second stroke, compared to 12% of those taking placebo. According to the National Institutes of Health, this suggests that 28 strokes or heart attacks might be prevented for every 1,000 people who take Actos for up to five years. Additionally, Actos was found to reduce the risk of Type 2 diabetes by 52%, with 4% of participants taking the medicine developing the condition, compared to 8% of those receiving placebo.
The researchers do not currently know how the medicine reduces the risk of stroke, but suspect that it may improve the function of the blood vessels by reducing inflammation and insulin resistance and helping to manage fats in the body.
“This trial provides fairly strong evidence that insulin resistance is an important new target for prevention of stroke,” noted lead study author Walter Kernan, MD. “Actos represents a new option for patients who have had a stroke to help prevent a future stroke.”
The medicine, was, however, linked to a variety of serious side effects in the study, including weight gain of 10 pounds or more, swelling of the feet and ankles, and broken bones requiring surgery or hospitalization. Further research is needed to evaluate exactly how Actos decreases the risk of stroke and increases bone fracture risk, with an eye toward increasing the benefits and minimizing the side effects, the researchers note. “Actos may be an option for patients who have had a stroke or mini-stroke, but its role will have to emerge from a debate among scientists about our results,” said Kernan.
For more information, see the article “Diabetes drug may prevent recurring strokes” or the study in The New England Journal of Medicine. And to learn more about Actos, see “Diabetes Medicine: Thiazolidinediones” by certified diabetes educator Amy Campbell, MS, RD, LDN, CDE.
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