| Abstract: |
Decades of epidemiologic studies have strongly suggested a major, and probably independent, role of insulin resistance in the genesis and progression of macrovascular diseases, including stroke. New drug agents that enhance insulin sensitivity present an opportunity to test the link between insulin resistance and macrovascular diseases. After an introductory section on the role of insulin resistance in stroke, this article describes the Insulin Resistance Intervention after Stroke (IRIS) Trial, undertaken to help resolve the controversy about insulin resistance and stroke. The IRIS trial will assess the effectiveness of pioglitazone in improving cardiovascular outcomes in insulin-resistant nondiabetic ischemic stroke survivors. The primary end points are recurrent stroke and myocardial infarction. The secondary end points include the individual components of the primary end point, acute coronary syndrome, development of overt type 2 diabetes mellitus, all-cause mortality, cognitive decline, and hospitalization for heart failure. Patients were still being recruited to the trial as of June 2007. 1 table. |