{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T01:08:48Z","timestamp":1777943328676,"version":"3.51.4"},"reference-count":17,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2024,1,8]],"date-time":"2024-01-08T00:00:00Z","timestamp":1704672000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U01NS044876"],"award-info":[{"award-number":["U01NS044876"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Stroke"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>In stroke patients with insulin resistance (IR), post-stroke cognitive impairment (PSCI) is associated with higher risk of recurrent stroke, but the effect of pioglitazone on that risk has not been explored. The goal of this study was to compare the secondary stroke prevention effect of pioglitazone against placebo in patients with versus without PSCI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We studied patients enrolled in the Insulin Resistance Intervention after Stroke (IRIS) trial with a post-stroke modified Mini-Mental State Examination (3MS) cognitive assessment (mean time of assessment: 79\u2009days post-stroke). We considered a baseline score of\u2009\u2a7d\u200988 on the 3MS to indicate global PSCI, and domain-specific summary scores in the lowest quartile to indicate attention, language, memory, orientation, and visuospatial impairments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>In n\u2009=\u20093338 patients with IR, the effect of pioglitazone versus placebo on secondary stroke significantly differed by initial post-stroke global (interaction p\u2009=\u20090.0127) and memory impairment status (interaction p\u2009=\u20090.0003). Hazard ratios (HRs) were time-dependent such that, among those with either global or memory impairment, pioglitazone has an increasingly stronger protective effect at later timepoints. There was no statistically significant effect of pioglitazone among those without either global or memory impairment. The effect of pioglitazone versus placebo on myocardial infarction (MI) also significantly differed by global impairment status (interaction p\u2009=\u20090.030). Pioglitazone was protective among those with global impairment (HR\u2009=\u20090.23 [95% CI: 0.08, 0.71]) but not among those without (HR\u2009=\u20090.88 [95% CI: 0.59, 1.31]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>These data indicate that pioglitazone treatment may be more effective at reducing risk of recurrent stroke and MI in stroke patients with PSCI. Simple cognitive testing 2\u20133\u2009months post-stroke may identify patients for whom treatment would be most beneficial.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17474930231225568","type":"journal-article","created":{"date-parts":[[2023,12,26]],"date-time":"2023-12-26T23:11:11Z","timestamp":1703632271000},"page":"414-421","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Effect of pioglitazone on vascular events in post-stroke cognitive impairment: Post hoc analysis of the IRIS trial"],"prefix":"10.1177","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1240-6767","authenticated-orcid":false,"given":"Kat","family":"Schmidt","sequence":"first","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melinda C.","family":"Power","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Ciarleglio","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5526-1342","authenticated-orcid":false,"given":"Zurab","family":"Nadareishvili","sequence":"additional","affiliation":[{"name":"Department of Neurology, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA"},{"name":"Stroke Center, Virginia Hospital Center, Arlington, VA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,1,8]]},"reference":[{"key":"bibr1-17474930231225568","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000430"},{"key":"bibr2-17474930231225568","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2022.106744"},{"key":"bibr3-17474930231225568","volume":"53","author":"De Havenon 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