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Pioglitazone Use and Reduced Risk of Dementia in Patients With Diabetes Mellitus With a History of Ischemic Stroke

 Junghee Ha  ;  Dong-Woo Choi  ;  Kwang Joon Kim  ;  Keun You Kim  ;  Chung Mo Nam  ;  Eosu Kim 
 NEUROLOGY, Vol.100(17) : E1799-E1811, 2023-04 
Journal Title
Issue Date
Diabetes Mellitus, Type 2* / complications ; Humans ; Hypoglycemic Agents / adverse effects ; Ischemic Stroke* / drug therapy ; Myocardial Ischemia* ; Pioglitazone / adverse effects ; Stroke* / epidemiology
Background and ObjectivesPrevious studies have reported the protective effect of pioglitazone on dementia in patients with type 2 diabetes mellitus (DM). Recent studies have shown that pioglitazone also lowers the risk of primary and recurrent stroke. Understanding the characteristics of patients particularly associated with the benefits of pioglitazone would facilitate its personalized use by specifying subpopulations during routine clinical care. The aim of this study was to examine the effects of pioglitazone use on dementia in consideration of stroke occurrence.MethodsUsing nationwide longitudinal data of patients with DM from the Korean National Health Insurance Service DM cohort (2002-2017), we investigated the association of pioglitazone use with incident dementia in patients with new-onset type 2 DM. The heterogeneity of the treatment effect was examined using exploratory analyses. Using a multistate model, we assessed the extent to which incident stroke affects the association between pioglitazone use and dementia.ResultsPioglitazone use was associated with a reduced risk of dementia, compared with nonuse (adjusted hazard ratio [aHR] = 0.84, 95% CI 0.75-0.95); the risk reduction in dementia was greater among patients with a history of ischemic heart disease or stroke before DM onset (aHR = 0.46, 95% CI 0.24-0.90; aHR = 0.57, 95% CI 0.38-0.86, respectively). The incidence of stroke was also reduced by pioglitazone use (aHR = 0.81, 95% CI 0.66-1.00). However, when the stroke developed during the observation period of pioglitazone use, such lowered risk of dementia was not observed (aHR = 1.27, 95% CI 0.80-2.04).DiscussionPioglitazone use is associated with a lower risk of dementia in patients with DM, particularly in those with a history of stroke or ischemic heart disease, suggesting the possibility of applying a personalized approach when choosing pioglitazone to suppress dementia in patients with DM.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Preventive Medicine (예방의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Psychiatry (정신과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Kwang Joon(김광준) ORCID logo https://orcid.org/0000-0002-5554-8255
Kim, Keun You(김근유) ORCID logo https://orcid.org/0000-0001-7192-2828
Kim, Eosu(김어수) ORCID logo https://orcid.org/0000-0001-9472-9465
Nam, Chung Mo(남정모) ORCID logo https://orcid.org/0000-0003-0985-0928
Ha, Junghee(하정희) ORCID logo https://orcid.org/0000-0002-4217-3570
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