Antidiabéticos orais na prevenção de recorrência de evento isquêmico: revisão sistemática.
DOI:
https://doi.org/10.34024/rnc.2024.v32.19298Palavras-chave:
Acidente Vacular Cerebral, Antidiabéticos orais, Resistência à InsulinaResumo
Introdução. O acidente vascular cerebral (AVC) é um problema cerebrovascular bem prevalente que se associa com condições de desregulação glicêmica, como o diabetes mellitus e a pré-diabetes. Objetivo. Analisar a efetividade e a segurança do uso de medicamentos antidiabéticos orais na prevenção da recorrência de evento cerebral isquêmico. Método. Revisão sistemática envolvendo o uso de antidiabéticos orais para a prevenção de novos eventos isquêmicos em pacientes que tiveram acidente vascular cerebral isquêmico (AVCi) ou ataque isquêmico transitório (AIT) com resistência à insulina ou pré-diabetes. Resultados. no artigo incluído nesta revisão foi possível observar que em um total de 3876 participantes, com acompanhamento mediano de 4,8 anos, houve uma diminuição na quantidade percentual de recorrência de novos eventos isquêmicos, ocorreram 155 AVC em 138 pacientes no grupo intervenção, e 222 AVC em 181 participantes no grupo placebo (risco em 5 anos, 8,0% em comparação com 10,7%; HR, 0,75; IC 95%, 0,60–0,94; P=0,01). Os resultados se mantiveram mesmo após ajuste para características basais (HR, 0.74; 95% CI, 0.59–0.92; P=0,007). Pacientes no grupo intervenção apresentaram bem mais casos de edema, ganho de peso, falta de ar, e fraturas do que os pacientes do grupo placebo, mas sem diferença significante para qualquer tipo de câncer, hospitalização e mortalidade. Conclusões. A pioglitazona apresentou uma tendência favorável como tratamento preventivo para novo AVC em pacientes pré-diabéticos ou com resistência à insulina, especialmente para alguns subgrupos de acidente vascular cerebral isquêmico. Ainda assim, mais estudos precisam ser realizados para confirmar tais dados.
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Saco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013;44:2064-89. https://doi.org/10.1161/str.0b013e318296aeca
Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA, Hennerici MG. Classification of stroke subtypes. Cerebrovas Dis 2009;27:493-501. https://doi.org/10.1159/000210432
Coupland AP, Thapar A, Qureshi MI, Jenkins H, Davies AH. The definition of stroke. J Royal Soc Med 2017;110:9-12. https://doi.org/10.1177/0141076816680121
Shou J, Zhou L, Zhu S, Zhang X. Diabetes is an Independent Risk Factor for Stroke Recurrence in Stroke Patients: A Meta-analysis. J Stroke Cerebrovasc Dis 2015;24:1961-8. https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.04.004
Pan Y, Wang Y, Li H, Gaisano HY, Wang Y, He Y. Association of Diabetes and Prognosis of Minor Stroke and Its Subtypes: A Prospective Observational Study. PLoS ONE 2016;11:e0153178. https://doi.org/10.1371/journal.pone.0153178
Mitsios JP, Ekinci EI, Mitsios GP, Churilov L, Thijs V. Relationship Between Glycated Hemoglobin and Stroke Risk: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2018;7:e007858. https://doi.org/10.1161/jaha.117.007858
Petersmann A, Müller-Wieland D, Müller UA, Landgraf R, Nauck M, Freckmann G, et al. Definition, Classification and Diagnosis of Diabetes Mellitus. Exp Clin Endocrinol Diabetes 2019;127:S1-7. https://doi.org/10.1055/a-1018-9078
American Diabetes Association Professional Practice Committee. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2022. Diabetes Care 2022;45(Supp1):S17-38. https://doi.org/10.2337/dc22-S002
Kernan WN, Viscoli CM, Inzucchi SE, Brass LM, Bravata DM, Shulman GI, et al. Prevalence of abnormal glucose tolerance following a transient ischemic attack or ischemic stroke. Arch Intern Med 2005;165:227-33. https://doi.org/10.1001/archinte.165.2.227
Vermeer SE, Sandee W, Algra A, Koudstaal PJ, Kappelle LJ, Dippel DW, et al. Impaired glucose tolerance increases stroke risk in nondiabetic patients with transient ischemic attack or minor ischemic stroke. Stroke 2006;37:1413-7. https://doi.org/10.1161/01.str.0000221766.73692.0b
Lee M, Saver JL, Hong KS, Song S, Chang KH, Ovbiagele B. Effect of pre-diabetes on future risk of stroke: meta-analysis. BMJ 2012;344:e3564. https://doi.org/10.1136/bmj.e3564
Jing J, Pan Y, Zhao X, Zheng H, Jia Q, Mi D, et al. Insulin Resistance and Prognosis of Nondiabetic Patients With Ischemic Stroke: The ACROSS-China Study (Abnormal Glucose Regulation in Patients With Acute Stroke Across China). Stroke 2017;48:887-93. https://doi.org/10.1161/strokeaha.116.015613
Lee M, Saver JL, Liao HW, Lin CH, Ovbiagele B. Pioglitazone for Secondary Stroke Prevention: A Systematic Review and Meta-Analysis. Stroke 2017;48:388-93. https://doi.org/10.1161/strokeaha.116.013977
Easton JD, Saver JL, Albers GW, Alberts MJ, Chaturvedi S, Feldmann E, et al. Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke 2009;40:2276-93. https://doi.org/10.1161/strokeaha.108.192218
Freeman AM, Acevedo LA, Pennings N. Insulin Resistance. In: StatPearls (Internet). Treasure Island (FL): StatPearls Publishing, 2022. http://www.ncbi.nlm.nih.gov/books/nbk507839/
Verhagen AP, de Vet HCW, de Bie RA, Kessels AGH, Boers M, Bouter LM, et al. The Delphi List: A Criteria List for Quality Assessment of Randomized Clinical Trials for Conducting Systematic Reviews Developed by Delphi Consensus. J Clin Epidemiol 1998;51:1235-41. https://doi.org/10.1016/S0895-4356(98)00131-0
Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019;366:I4898. https://doi.org/10.1136/bmj.l4898
McGuinness LA, Higgins JPT. Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments. Res Syn Meth 2020;12:1-7. https://doi.org/10.1002/jrsm.1411
Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.4 (updated August 2023). Cochrane, 2023. Disponível em: www.training.cochrane.org/handbook
Yaghi S, Furie KL, Viscoli CM, Kamel H, Gorman M, Dearborn J, et al. Pioglitazone prevents stroke in patients with a recent transiente ischemic attack or ischemic stroke: a planned secondary analysis of the IRIS trial (Insulin Resistance Intervention After Stroke). Circulation 2018;137:455-63. https://doi.org/10.1161/CIRCULATIONAHA.117.030458
Tanaka R, Yamashiro K, Okuma Y, Shimura H, Nakamura S, Ueno Y, et al. Effects of pioglitazone for secondary stroke prevention in patients with impaired glucose tolerance and newly diagnosed diabetes: the J-SPIRIT study. J Atheroscl Thrombosis 2015;22:1305-16. https://doi.org/10.5551/jat.30007
Eggleton JS, Jialal I. Thiazolidinediones. In: StatPearls (Internet). Treasure Island (FL): StatPearls Publishing; 2023. Disponível em: https://www.ncbi.nlm.nih.gov/books/NBK551656/
Chaudhury A, Duvoor C, Reddy DVS, Kraleti S, Chada A, Ravilla R, et al. Clinical review of antidiabetic drugs: implications for type 2 diabetes mellitus management. Front Endocrinol 2017;8:224539. https://doi.org/10.3389/fendo.2017.00006
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Copyright (c) 2024 Luis Miguel Moraes Araujo, Cristiane Fiquene Conti, Márcio Moysés de Oliveira
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Aprovado 2024-12-09
Publicado 2024-12-13
