Effect of pioglitazone on vascular events in post-stroke cognitive impairment: Post hoc analysis of the IRIS trial.

IF 6.3 2区医学 Q1 CLINICAL NEUROLOGY International Journal of Stroke Pub Date : 2024-04-01 Epub Date: 2024-01-08 DOI:10.1177/17474930231225568

Kat Schmidt, Melinda C Power, Adam Ciarleglio, Zurab Nadareishvili

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Abstract

Background: In stroke patients with insulin resistance (IR), post-stroke cognitive impairment (PSCI) is associated with higher risk of recurrent stroke, but the effect of pioglitazone on that risk has not been explored. The goal of this study was to compare the secondary stroke prevention effect of pioglitazone against placebo in patients with versus without PSCI.

Methods: We studied patients enrolled in the Insulin Resistance Intervention after Stroke (IRIS) trial with a post-stroke modified Mini-Mental State Examination (3MS) cognitive assessment (mean time of assessment: 79 days post-stroke). We considered a baseline score of ⩽ 88 on the 3MS to indicate global PSCI, and domain-specific summary scores in the lowest quartile to indicate attention, language, memory, orientation, and visuospatial impairments.

Results: In n = 3338 patients with IR, the effect of pioglitazone versus placebo on secondary stroke significantly differed by initial post-stroke global (interaction p = 0.0127) and memory impairment status (interaction p = 0.0003). Hazard ratios (HRs) were time-dependent such that, among those with either global or memory impairment, pioglitazone has an increasingly stronger protective effect at later timepoints. There was no statistically significant effect of pioglitazone among those without either global or memory impairment. The effect of pioglitazone versus placebo on myocardial infarction (MI) also significantly differed by global impairment status (interaction p = 0.030). Pioglitazone was protective among those with global impairment (HR = 0.23 [95% CI: 0.08, 0.71]) but not among those without (HR = 0.88 [95% CI: 0.59, 1.31]).

Conclusion: These data indicate that pioglitazone treatment may be more effective at reducing risk of recurrent stroke and MI in stroke patients with PSCI. Simple cognitive testing 2-3 months post-stroke may identify patients for whom treatment would be most beneficial.

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吡格列酮对脑卒中后认知障碍患者血管事件的影响：IRIS试验的事后分析。

背景在患有胰岛素抵抗（IR）的卒中患者中，卒中后认知障碍（PSCI）与较高的复发性卒中风险相关，但吡格列酮对该风险的影响尚未得到探讨。本研究的目的是比较吡格列酮与安慰剂对有和无 PSCI 患者的中风二级预防效果：我们对参加脑卒中后胰岛素抵抗干预（IRIS）试验的患者进行了脑卒中后改良迷你精神状态检查（3MS）认知评估（平均评估时间：脑卒中后 79 天）。我们认为，3MS基线得分≤88分表示总体PSCI，而特定领域总分处于最低四分位表示注意力、语言、记忆、定向力和视觉空间障碍：在3338名IR患者中，吡格列酮与安慰剂对继发性脑卒中的影响因脑卒中后初始全局（交互作用P = 0.0127）和记忆障碍状态（交互作用P = 0.0003）而有显著差异。危险比（HRs）与时间有关，因此在有全面或记忆障碍的患者中，吡格列酮在较晚时间点的保护作用越来越强。在没有全面或记忆障碍的人群中，吡格列酮的作用在统计学上并不显著。与安慰剂相比，吡格列酮对心肌梗死（MI）的影响也因整体受损状况而有显著差异（交互作用 p = 0.030）。吡格列酮对有整体功能障碍的患者有保护作用（HR = 0.23; 95% CI: 0.08, 0.71），但对无整体功能障碍的患者没有保护作用（HR = 0.88; 95% CI: 0.59, 1.31）：这些数据表明，吡格列酮治疗可更有效地降低 PSCI 中风患者复发中风和心肌梗死的风险。脑卒中后 2-3 个月的简单认知测试可确定哪些患者接受治疗最有效。

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来源期刊

International Journal of Stroke 医学-外周血管病

CiteScore

13.90

自引率

6.00%

发文量

132

审稿时长

6-12 weeks

期刊介绍： The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.