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Glitazones reduce stroke recurrence

A glitazone can reduce the risk of recurrent stroke significantly in high-risk patients with type 2 diabetes, research concludes.

The study, an analysis of the Proactive trial published online by Stroke, found pioglitazone reduced the risk of a second stroke when given as an add-on to other medications.

There was some sign that pioglitazone might also reduce the primary endpoint of all-cause death or a cardiovascular event.

The event rate was 20.2 per cent in the pioglitazone group versus 25.3 per cent in the placebo group, although the result fell short of statistical significance.

But there was a significant fall in the rate of cardiovascular death, non-fatal MI or non-fatal stroke, where the pioglitazone arm had an event rate of 13.0 per cent versus 17.7 per cent for those on placebo.

The researchers said pioglitazone only appeared to affect recurrent stroke, rather than first stroke – perhaps because the risk of a first stroke was low, at 2.6 per cent over three years, compared with 10.5 per cent for those with a previous stroke.

Professor Robert Wilcox, one of the authors and head of the department of cardiovascular medicine, University of Nottingham, said: 'Pioglitazone significantly reduced the risk of recurrent fatal and non-fatal stroke in high-risk patients with type 2 diabetes but had no effect on first strokes.'

Proactive was a prospective, double-blind trial in 5,238 patients with type 2 diabetes and a history of macrovascular disease.

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