背景:缺血性卒中患者合并糖尿病是复发性卒中和心血管并发症的高风险。吡格列酮,一种噻唑烷二酮,已被证明可以减少缺血性卒中和2型糖尿病(T2D)或胰岛素抵抗患者的心血管并发症。洛格列酮是一种新型的噻唑烷二酮药物,可改善胰岛素抵抗,具有与吡格列酮相似的血糖功效。使用基于人群的健康声明数据,我们评估了在缺血性卒中和T2D患者中,洛格列酮是否具有继发性心血管预防作用.
方法:本研究采用嵌套病例对照设计。从韩国全国范围的健康索赔数据来看,我们确定了2014-2018年因急性缺血性卒中入院的T2D患者.定义患有主要结局的病例(复发性卒中的复合,心肌梗塞,和全因死亡)在2020年12月之前。通过发病率密度抽样为每个病例选择三个对照,这些对照在病例发生时处于危险之中,性别完全匹配,年龄,合并症的存在,和药物。作为安全结果,我们还根据使用洛格列酮评估了心力衰竭(HF)的风险.
结果:从70,897名T2D急性缺血性卒中患者的队列中,选择20,869例病例和62,607例对照。在多变量条件逻辑回归中,使用洛格列酮(校正OR0.74;95%CI0.61~0.90;p=0.002)和吡格列酮(校正OR0.71;95%CI0.64~0.78;p<0.001)治疗与主要结局风险较低显著相关.在HF的安全结果分析中,洛格列酮治疗未增加HF的风险(校正OR0.90;95%CI0.66-1.22;p=0.492).
结论:在缺血性卒中的T2D患者中,与吡格列酮相似,洛格列酮可降低心血管并发症的风险,但不会增加HF的风险.有必要进一步研究洛格列酮的心脏保护作用,一种新型的噻唑烷二酮.
Ischemic stroke patients with diabetes are at high risk for recurrent stroke and cardiovascular complications. Pioglitazone, a type of thiazolidinedione, has been shown to reduce cardiovascular complications in patients with ischemic stroke and type 2 diabetes (T2D) or insulin resistance.
Lobeglitazone is a novel thiazolidinedione agent that improves insulin resistance and has similar glycemic efficacy to pioglitazone. Using population-based health claims data, we evaluated whether
lobeglitazone has secondary cardiovascular preventive effects in patients with ischemic stroke and T2D.
This study has a nested case-control design. From nationwide health claims data in Korea, we identified patients with T2D admitted for acute ischemic stroke in 2014-2018. Cases were defined who suffered the primary outcome (a composite of recurrent stroke, myocardial infarction, and all-cause death) before December 2020. Three controls were selected by incidence density sampling for each case from those who were at risk at the time of their case occurrence with exact matching on sex, age, the presence of comorbidities, and medications. As a safety outcome, we also evaluated the risk of heart failure (HF) according to the use of
lobeglitazone.
From the cohort of 70,897 T2D patients with acute ischemic stroke, 20,869 cases and 62,607 controls were selected. In the multivariable conditional logistic regression, treatment with
lobeglitazone (adjusted OR 0.74; 95% CI 0.61-0.90; p = 0.002) and pioglitazone (adjusted OR 0.71; 95% CI 0.64-0.78; p < 0.001) were significantly associated with a lower risk for the primary outcome. In a safety outcome analysis for HF, treatment with lobeglitazone did not increase the risk of HF (adjusted OR 0.90; 95% CI 0.66-1.22; p = 0.492).
In T2D patients with ischemic stroke,
lobeglitazone reduced the risk of cardiovascular complications similar to that of pioglitazone without an increased risk of HF. There is a need for further studies on the cardioprotective role of lobeglitazone, a novel thiazolidinedione.