From the Guidelines
Patients with a history of cerebrovascular accident (CVA or stroke) should exercise caution when considering Actos (pioglitazone) due to potential increased risk of heart failure and other cardiovascular events, although a recent study suggests it may reduce the risk of stroke or myocardial infarction in patients with insulin resistance 1. When evaluating the use of Actos in patients with CVA, it's essential to weigh the potential benefits against the risks. The IRIS trial, which involved 3876 patients with stroke and insulin resistance, found that pioglitazone produced a 24% relative risk reduction in stroke or myocardial infarction 1. However, thiazolidinediones like Actos can increase the risk of heart failure due to their sodium retentive properties, which is a concern for patients with established heart failure or those at risk of developing it. Key considerations for using Actos in patients with CVA include:
- Monitoring for signs of fluid overload and heart failure
- Careful selection of patients without established heart failure
- Awareness of the potential increased risk of bladder cancer with long-term use
- Consideration of alternative medications with proven cardiovascular benefits, such as metformin, GLP-1 receptor agonists, or SGLT2 inhibitors It's crucial to consult with a healthcare provider to determine the best course of treatment for individual patients, taking into account their unique medical history and risk factors.
From the Research
Patient with CVA taking Actos (Pioglitazone)
- The studies provide information on the cardiovascular effects of pioglitazone in patients with type 2 diabetes, but do not directly address the question of whether a patient with a history of cerebral vascular accident (CVA) can take Actos (pioglitazone) 2, 3, 4, 5, 6.
- However, the studies suggest that pioglitazone may have a favorable effect on ischemic cardiovascular events, including stroke, with a lower risk of death, myocardial infarction, or stroke compared to other treatments 3, 5.
- Additionally, pioglitazone was associated with a lower risk of mortality and congestive heart failure compared to sulfonylureas in some studies 4, 5.
- However, one study found that pioglitazone was associated with an increased risk of serious heart failure, although without an associated increase in mortality 3.
- Another study found that patients who initiated rosiglitazone had a higher risk of heart failure than patients who initiated metformin, but there was no significant difference in risk between patients who initiated pioglitazone and metformin therapy 6.
Cardiovascular Risks and Benefits
- The studies suggest that pioglitazone may have both cardiovascular benefits and risks, and the decision to prescribe it to a patient with a history of CVA should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history 2, 3, 4, 5, 6.
- Patients with a history of CVA may be at increased risk of cardiovascular events, and the use of pioglitazone in these patients should be carefully considered and monitored 3, 5.
- The benefits and risks of pioglitazone should be weighed against those of other treatments, and patients should be closely monitored for signs of cardiovascular events or other adverse effects 2, 3, 4, 5, 6.