Tuesday, October 18, 2011

Does Actos Reduce Stroke Risk?



Not to be outdone by upstart Juvisync, a new study shows that long-time type 2 diabetes drug, Actos, may also have blood vessel benefits.
The small study of 52 type 2 diabetes patients, published in the October Journal of the American College of Cardiology found that patients taking pioglitazone (Actos) had reduced inflammation associated with plaque deposits in the main arteries serving the head and neck. Such deposits are thought to increase the risk of stroke. (Link to published site)


As reported on by MedPage Today, the researchers randomly assigned half of the patients to receive Actos and half to receive glimepiride (Amaryl) for four months. All patients had evidence of plaque deposits in the carotid arteries, which they measured at the start of the study and at the end of the study. They also measured blood glucose, blood pressure, weight and waist size.

At the start of the study there was no difference between the two groups in terms of plaque deposits. After four months the Actos group had significantly decreased the plaque inflammation but there was no change in the Amaryl group.

Both groups had reduced fasting blood sugar with similar A1c levels. The Actos group had increased weight and waist size, but decreased blood levels of high sensitivity C-reactive protein. CRP is a blood test that measures general levels of inflammation in the body. High levels of high sensitivity CRP have been associated with risk for sudden heart attacks. The Amaryl group had an increase in the average level of high sensitivity C-reactive protein.

There were no significant changes in blood pressure, LDL cholesterol or triglycerides in either group.

In a commentary that accompanied the study, Dr. Ahmed Tawakol of Massachusetts General Hospital in Boston, and Dr. Aloke Finn of Emory University in Atlanta, wrote that while the results showed a reduction in inflammation, it is unknown if this translates into reducing the risks of heart attack or stroke.

“It is important to note that it remains unclear whether lowering plaque inflammation is the mechanism by which statins and pioglitazone therapy decrease cardiovascular events,” they wrote, “or even whether, in general, reductions in inflammation would translate into clinical benefit.”

The study investigators acknowledge the small size of the study and the limited ability to draw conclusions about the blood vessel benefits of Actos, but suggest that their study shows Actos might be part of a strategy for addressing vascular disease in patients with type 2 diabetes.

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