GLP-1RAs for Ischemic Stroke Prevention in Patients With Type 2 Diabetes Without Established Atherosclerotic Cardiovascular Disease

Mar 11, 2022Diabetes care

GLP-1 Receptor Agonists and Stroke Prevention in Type 2 Diabetes Patients Without Heart or Artery Disease

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Abstract

GLP-1 receptor agonists (GLP-1RAs) may significantly reduce the risk of ischemic stroke hospitalization for patients with type 2 diabetes when used for over 251 days.

A total of 6,534 patients were included in the study, with a median follow-up period of 3 years.
The overall risk of ischemic stroke hospitalization for GLP-1RA users was not significantly lower than for nonusers.
Users of GLP-1RAs with a supply exceeding 251 days showed a significantly lower risk of hospitalization for ischemic stroke.
A higher cumulative dose of GLP-1RAs, defined as over 1,784 mg, was associated with a significantly lower risk of hospitalization for ischemic stroke.
Subgroup analyses did not reveal significant differences in the effect of GLP-1RAs based on various baseline characteristics.

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OBJECTIVE: We assessed the effect of glucagon-like peptide 1 receptor agonists (GLP-1RAs) on ischemic stroke prevention in the Asian population with type 2 diabetes (T2D) without established cardiovascular disease.

RESEARCH DESIGN AND METHODS: This retrospective cohort study examined data obtained from the Taiwan National Health Insurance Research Database for the period from 1998 to 2018. The follow-up ended upon the occurrence of hospitalization for ischemic stroke. The median follow-up period was 3 years. The effect of GLP-1RA exposure time on the development of hospitalization for ischemic stroke was assessed.

RESULTS: The GLP-1RA and non-GLP-1RA user groups both included 6,534 patients. Approximately 53% of the patients were women, and the mean age was 49 ± 12 years. The overall risk of ischemic stroke hospitalization for GLP-1RA users was not significantly lower than that for GLP-1RA nonusers (adjusted hazard ratio [HR] 0.69 [95% CI 0.47-1.00]; P = 0.0506), but GLP-1RA users with a >251-day supply during the study period had a significantly lower risk of ischemic stroke hospitalization than GLP-1RA nonusers (adjusted HR 0.28 [95% CI 0.11-0.71]). Higher cumulative dose of GLP-1 RAs (>1,784 mg) was associated with significantly lower risk of ischemic stroke hospitalization. The subgroup analyses defined by various baseline features did not reveal significant differences in the observed effect of GLP-1RAs.

CONCLUSIONS: Longer use and higher dose of GLP-1 RAs were associated with a decreased risk of hospitalization for ischemic stroke among Asian patients with T2D who did not have established atherosclerotic cardiovascular diseases, but who did have dyslipidemia or hypertension.

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GLP-1RAs for Ischemic Stroke Prevention in Patients With Type 2 Diabetes Without Established Atherosclerotic Cardiovascular Disease

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