Thiazolidinediones Decrease the Recurrence of Intracerebral Hemorrhage in Type 2 Diabetes Mellitus Patients: A Nested Case-Control Study

Cheng-Di Chiu; You-Pen Chiu; Hei-Tung Yip; Hui-Ru Ji; Der-Yang Cho; Irene Han-Juo Cheng; Cho-Yi Chen

doi:10.1159/000539001

Thiazolidinediones Decrease the Recurrence of Intracerebral Hemorrhage in Type 2 Diabetes Mellitus Patients: A Nested Case-Control Study

Neuroepidemiology. 2024 May 3:1-14. doi: 10.1159/000539001. Online ahead of print.

Authors

Cheng-Di Chiu^{1

2

3

4}, You-Pen Chiu^{5

6}, Hei-Tung Yip^{5

7}, Hui-Ru Ji^{5

6}, Der-Yang Cho⁸, Irene Han-Juo Cheng^{9

10}, Cho-Yi Chen^{10

11}

Affiliations

¹ School of Medicine, China Medical University, Taichung, Taiwan, cdchiu4046@gmail.com.
² Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan, cdchiu4046@gmail.com.
³ Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan, cdchiu4046@gmail.com.
⁴ Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, cdchiu4046@gmail.com.
⁵ School of Medicine, China Medical University, Taichung, Taiwan.
⁶ Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan.
⁷ Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
⁸ Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan.
⁹ Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan.
¹⁰ Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
¹¹ Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan.

PMID: 38705143
DOI: 10.1159/000539001

Abstract

Introduction: Preclinical evidence demonstrated the therapeutic potential of thiazolidinediones (TZDs) for the treatment of intracerebral hemorrhage (ICH). The present study conducted an investigation of cerebrovascular and cardiovascular outcomes following ICH in patients with type 2 diabetes mellitus (T2DM) treated with or without TZDs.

Methods: This retrospective nested case-control study used data from the Taiwan National Health Insurance Research Database. A total of 62,515 T2DM patients who were hospitalized with a diagnosis of ICH were enrolled, including 7,603 TZD users. Data for TZD non-users were extracted using propensity score matching. Primary outcomes included death and major adverse cardiovascular events (MACEs), which were defined as a composite of ischemic stroke, hemorrhagic stroke (HS), acute myocardial infarction, and congestive heart failure. Patients aged <20 years with a history of traumatic brain injury or any prior history of MACEs were excluded.

Results: TZD users had significantly lower MACE risks compared with TZD non-users following ICH (adjusted hazard ratio [aHR]: 0.90, 95% confidence interval [CI]: 0.85-0.94, p < 0.001). The most significant MACE difference reported for TZD users was HS, which possessed lower incidence than in TZD non-users, especially for the events that happened within 3 months following ICH (aHR: 0.74, 95% CI: 0.62-0.89 within 1 month, p < 0.01; aHR: 0.68, 95% CI: 0.54-0.85 between 1 and 3 month).

Conclusion: The use of TZD in patients with T2DM was associated with a lower risk of subsequent HS and mortality following ICH.

Keywords: Cardiovascular risk; Recurrent hemorrhagic stroke; Spontaneous intracerebral hemorrhage; Thiazolidinediones; Type 2 diabetes mellitus.