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Letter by Castilla-Guerra et al Regarding Article, "Pioglitazone for Secondary Stroke Prevention: A Systematic Review and Meta-Analysis".

In an interesting meta-analysis of 3 randomized controlled trials with 4980 participants, Lee et al1 conclude that pioglitazone reduces the risk of recurrent stroke and major vascular events in ischemic stroke and transient ischemic attack patients with glucose metabolism disorders. These results are important for the management of diabetes mellitus.

In fact, until recently, no antidiabetic drug has been proven to reduce stroke incidence or recurrence, and besides, glucose lowering has generally been disappointing in terms of cardiovascular protection in the context of diabetes mellitus.1,2 However, there is distinct hope that newer antidiabetic agents will have cardiovascular benefits independent of glycemic control.

Since 2008, the Food and Drug Administration specifies the need to establish cardiovascular safety of new diabetes mellitus …