GLP-1 receptor agonists linked to reduced stroke risk in T2D

  • Bellastella G & al.
  • Stroke
  • 9 Dec 2019

  • International Clinical Digest
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Takeaway

  • Glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1RAs) may reduce risk for nonfatal stroke in patients with type 2 diabetes (T2D), which is noteworthy because intensive glycemic control has a negligible role in reducing this risk.

Study design

  • Meta-analysis of pooled data from 7 parallel-group, double-blind cardiovascular outcomes trials ranging from 1.3 to 5.4 years, with 27,977 participants with T2D randomly allocated to GLP-1RA and 28,027 to placebo.
  • Funding: None disclosed, but 2 authors list personal industry disclosures.

Key results

  • New nonfatal stroke incidence varied across placebo groups from 0.65/100 to 1.31/100 person-years.
  • Use of GLP-1RA was associated with reduced risk for nonfatal stroke (HR, 0.85; P=.002).
  • In single trials, only subcutaneous semaglutide and dulaglutide reduced stroke risk (39% and 24%, respectively).
  • GLP-1RAs were associated with reduced risk for both fatal (HR, 0.81; P=.150) and total stroke (HR, 0.84; P=.001).
  • Across all trials, there was nonsignificant association between HbA1c reduction and stroke risk (P=.096).
  • No association (P=.247) between body weight reduction and stroke risk.

Limitations

  • Aggregate data limit ability to delve further into subgroups.
  • Stroke was a secondary endpoint in all trials.
  • Patients with T2D with previous stroke poorly represented.
  • Limited trial number, follow-up duration.
  • No data on poststroke death, recurrent stroke.