IRIS Trial: Pioglitazone for Secondary Stroke Prevention
New England Journal of Medicine (2016)
Reduced recurrent stroke/MI by 24% in insulin-resistant patients with recent ischemic stroke.
How it works
Marek's Guided Optimization® Program combines advanced lab testing, a dedicated health coach and medical provider, and a personalized treatment plan, all built around your data.
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The process
1
Start your assessment
Complete your 45-min intake assessment
2
Get your labs drawn
4,000 partnered lab locations nationwide
3
Review with your coach
Screen-by-screen lab review
4
Receive your protocol
Treatment delivered to your door
Why Marek
The only program pairing you with a dedicated health coach and medical provider, built on precision diagnostics, with no subscription required.
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Meet our co-founder
Derek
Co-Founder · MPMD Podcast
"Over time, I found it incredibly difficult to get medical oversight for myself and my family that reflected the latest research, and that was preventative. That's why I started Marek Health."
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What we test
Every client's lab panel is hand-selected from 1,000+ available biomarkers, built around their specific goals.
Panel categories
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Treatments
700+ medical provider-prescribed therapies built from your labs. Browse by category or explore the full formulary.
Pioglitazone
Oral tablet (15mg)Available in all 50 statesMarketing purposes only. Actual medications, if prescribed, are dispensed by a licensed pharmacy.
weight
PioglitazonePioglitazone
PPAR-gamma agonist improving insulin sensitivity with significant NASH histologic improvement (PIVENS), cardiovascular risk reduction (PROactive), and stroke prevention (IRIS trial: 24% recurrent stroke/MI reduction).
NASH histology improvement (PIVENS)
HDL-C increase 10 to 15%
24% stroke/MI reduction (IRIS)
Potent insulin sensitization
No commitment · HSA/FSA eligibleNo commitment · HSA/FSA eligible
How it works
Mechanism of action
Activates PPAR-gamma nuclear receptors, redistributing fat from ectopic to subcutaneous depots, improving adiponectin, reducing hepatic/muscle lipotoxicity, and suppressing inflammatory cytokines.
The baseline panel.
Every Marek client receives this baseline panel before a provider review. Your provider may add additional biomarkers based on your health history, symptoms, and goals, pulling from 1,000+ available markers. See more biomarkers →
Hormone Profile
12 markers
Sex hormones
- Total TestosteroneLC/MS
- Free TestosteroneEquilibrium Dialysis
- Estradiol, Sensitive / UltrasensitiveLC/MS
- Sex Hormone Binding Globulin (SHBG)
- ProgesteroneLC/MSFemale panel
- Prolactin
- Luteinizing Hormone (LH)
- Follicle-Stimulating Hormone (FSH)
- hCG, Total, QuantitativeFemale panel, pre-menopause
Adrenals & neurosteroids
- Cortisol
- DHEA-S
Growth hormone / IGF-1
- Insulin-Like Growth Factor I (IGF-1)
Thyroid Status
3 markers
Thyroid hormones
- Thyroid Stimulating Hormone (TSH)
- Free T4
- Free T3
Heart Health
9 markers
Cardiovascular health
- Total Cholesterol
- HDL Cholesterol
- LDL Cholesterol
- LDL:HDL Ratio
- VLDL Cholesterol
- Triglycerides
- Apolipoprotein-B (ApoB)
- C-Reactive Protein, High Sensitivity (hsCRP)
- Lipoprotein(a) (Lp(a))
Metabolism
3 markers
Insulin sensitivity
- Blood Glucose
- Fasting Insulin
- HbA1c
Organ Function
26 markers
Liver & pancreas
- AST
- ALT
- Bilirubin, Total
- γ-Glutamyl Transferase (GGT)
Kidney function
- BUN
- Creatinine w/ eGFR
Comprehensive Metabolic Panel (CMP)
- Glucose
- Blood Urea Nitrogen (BUN)
- Creatinine
- eGFR
- BUN/Creatinine Ratio
- Sodium
- Potassium
- Chloride
- Carbon Dioxide, Total
- Calcium
- Protein, Total
- Albumin
- Globulin, Total
- Albumin/Globulin (A/G) Ratio
- Alkaline Phosphatase (ALP)
- AST
- ALT
Prostate health
- Prostate-Specific Antigen (PSA)Male panel
- Free PSAMale panel
- % Free PSAMale panel
Nutrient Status
31 markers
Vitamins & minerals
- Vitamin D, 25-OHD (25-Hydroxy)
- Magnesium, RBC
Iron status
- Iron
- Iron Saturation
- TIBC
- UIBC
- Ferritin
Complete Blood Count (CBC)
- White Blood Count (WBC)
- Red Blood Count (RBC)
- Hemoglobin (Hgb)
- Hematocrit (HCT)
- MCV
- MCH
- MCHC
- Red Cell Distribution Width (RDW)
- Platelets
- Neutrophils
- Neutrophils (Absolute)
- Lymphocytes
- Lymphocytes (Absolute)
- Neutrophil/Lymphocyte Ratio
- Monocytes
- Monocytes (Absolute)
- Eosinophils
- Eosinophils (Absolute)
- Basophils
- Basophils (Absolute)
- Immature Cells
- Immature Granulocytes
- Immature Granulocytes (Absolute)
- NRBC, w/ Reflex for Immature Cells
Clinical evidence
The research behind Pioglitazone.
Safety profile
Monitoring & safety information.
Commonly reported side effects
- Weight gain (2 to 4 kg)
- Peripheral edema
- Fracture risk (women)
- Mild anemia
Less common but serious risks
- Heart failure exacerbation (contraindicated NYHA III-IV)
- Bladder cancer (weak signal, debated)
- Bone loss/fractures
Generally not appropriate for
- Heart failure NYHA III-IV
- Active bladder cancer
- ALT >2.5x ULN
- Pregnancy
Typical monitoring
- HbA1c
- Weight and edema
- Liver function
- DXA (women, long-term)
- Heart failure symptoms
FAQ
Quick answers.
PPAR-gamma agonist improving insulin sensitivity with significant NASH histologic improvement (PIVENS), cardiovascular risk reduction (PROactive), and stroke prevention (IRIS trial: 24% recurrent stroke/MI reduction).
NASH histology improvement (PIVENS). HDL-C increase 10 to 15%. 24% stroke/MI reduction (IRIS). Potent insulin sensitization.
Common side effects include: weight gain (2 to 4 kg), peripheral edema, fracture risk (women), mild anemia. Most side effects are dose-dependent and may resolve with continued use or dose adjustment.
PPAR-gamma agonist improving insulin sensitivity with significant NASH histologic improvement (PIVENS), cardiovascular risk reduction (PROactive), and stroke prevention (IRIS trial: 24% recurrent stroke/MI reduction).
Treatments are dependent on licensed clinical prescription. Client costs vary based on individual labs and panel in treatments and services.