Pioglitazone, a drug used for type 2 diabetes, may prevent recurrent stroke and heart attacks in people with insulin resistance but without diabetes.
The results of the Insulin Resistance Intervention after Stroke (IRIS) trial, presented at the International Stroke Conference last month in Los Angeles and published in the New England Journal of Medicine, suggest a potential new method to prevent stroke and heart attack in high-risk patients who have already had one stroke or transient ischemic attack.
Pierre Fayad, M.D., professor in the UNMC Department of Neurological Sciences, and medical director, Nebraska Stroke Center, was the local principal investigator at UNMC in this large, international study, which was funded by the National Institutes of Health’s National Institute of Neurological Disorders and Stroke (NINDS).
“This is really exciting news,” Dr. Fayad said. “This is the first medication that has been shown to decrease the risk of stroke and heart disease in individuals at high risk for diabetes.”
The study was supported by the National Institutes of Health’s National Institute of Neurological Disorders and Stroke (NINDS).
The IRIS trial is the first study to provide evidence that a drug targeting cell metabolism may prevent secondary strokes and heart attacks even before diabetes develops. Insulin regulates metabolism and keeps blood sugar levels from getting too high, along with many other processes, in the body. Insulin resistance is a condition in which the body produces insulin but does not use it effectively.
“This study represents a novel approach to prevent recurrent vascular events by reversing a specific metabolic abnormality thought to increase the risk for future heart attack or stroke,” said Walter Koroshetz, M.D., director of the NINDS.
“The IRIS trial supports the value of more research to test the vascular benefits of other interventions such as exercise, diet and medications that have similar effects on metabolism as pioglitazone,” said Walter Kernan, M.D. professor of general medicine at Yale University School of Medicine, New Haven, Conn., and lead author of the study. Dr. Kernan was featured in a UNMC Today story when he visited UNMC in 2009.
Close to 4,000 patients from seven countries who had experienced an ischemic stroke or transient ischemic attack within the previous six months were randomized to receive pioglitazone or placebo for up to five years in addition to standard care. The UNMC/Nebraska Medicine study site enrolled a total of 49 patients from Nebraska and Iowa, ranking as the 11th highest enrolling site in the United States.