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Lobeglitazone, a novel thiazolidinedione, for secondary prevention in patients with ischemic stroke: a nationwide nested case-control study

 Joonsang Yoo  ;  Jimin Jeon  ;  Minyoul Baik  ;  Jinkwon Kim 
 CARDIOVASCULAR DIABETOLOGY, Vol.22(1) : 106, 2023-05 
Journal Title
Issue Date
Case-Control Studies ; Diabetes Mellitus, Type 2* / diagnosis ; Diabetes Mellitus, Type 2* / drug therapy ; Diabetes Mellitus, Type 2* / epidemiology ; Heart Failure* / diagnosis ; Heart Failure* / drug therapy ; Heart Failure* / epidemiology ; Humans ; Hypoglycemic Agents / adverse effects ; Insulin Resistance* ; Ischemic Stroke* ; Logistic Models ; Pioglitazone / adverse effects ; Secondary Prevention ; Stroke* / diagnosis ; Stroke* / epidemiology ; Stroke* / prevention & control ; Thiazolidinediones* / adverse effects
Cardiovascular Disease ; Cohort Study ; Lobeglitazone ; Thiazolidinedione ; Type 2 Diabetes Mellitus
Introduction: 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.

Methods: 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.

Results: 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).

Conclusions: 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.
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1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jinkwon(김진권) ORCID logo https://orcid.org/0000-0003-0156-9736
Baik, Minyoul(백민렬)
Yoo, Joon Sang(유준상) ORCID logo https://orcid.org/0000-0003-1169-6798
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