The absolute risk of a very severe stroke was 2.4% in patients with type 2 diabetes treated with GLP-1 receptor agonists compared to 6.1% for those treated with DPP-4 inhibitors.
Users of GLP-1 receptor agonists had a lower risk of very severe stroke than users of DPP-4 inhibitors, with an adjusted risk ratio of 0.49.
The adjusted risk ratio for 30-day mortality in GLP-1RA users was 0.55, indicating a potential reduction in short-term mortality.
For 365-day mortality, the adjusted risk ratio was 0.72, suggesting a possible decrease in long-term mortality among GLP-1RA users.
Findings indicate that treatment with GLP-1 receptor agonists may be associated with improved outcomes after an in patients with type 2 diabetes.
Simplified
BACKGROUND AND PURPOSE: Cardiovascular outcome trials demonstrate that (GLP-1RAs) reduce the risk of major adverse cardiovascular events in patients with type 2 diabetes (T2D), whereas (DPP-4is) have not shown cardiovascular benefits. We compared (AIS) with T2D treated with either a GLP-1RA or DPP-4i prior to the index stroke.
METHODS: This national cohort study included AIS patients with T2D from 2017 to 2020 in Denmark who were users of a GLP-1RA or DPP-4i. To be categorized as a user, we required at least 12 months of exposure and no concurrent treatment with another newer glucose-lowering medication during the last 3 months prior to the index stroke. GLP-1RA users were compared to users of DPP-4i while adjusting for the calendar year of index stroke, age, sex, comorbidity, and socioeconomic factors.
RESULTS: The study included 1567 AIS events with T2D; 593 were users of GLP-1RA and 974 of DPP-4i. The absolute risk of a very severe stroke was 2.4% (95% confidence interval [CI] = 1.2-3.7) in GLP-1RA users and 6.1% (95% CI = 4.6-7.7) in DPP-4i users. The corresponding adjusted risk ratio (aRR) of GLP-1RA versus DPP-4i was 0.49 (95% CI = 0.24-1.00). The aRRs of 30-day and 365-day mortality were 0.55 (95% CI = 0.32-0.94) and 0.72 (95% CI = 0.53-0.98), respectively.
CONCLUSIONS: The risk of a very severe stroke as well as the 30-day and 365-day poststroke mortality rates were lower among the AIS patients with comorbid T2D receiving GLP-1RA prior to the index stroke compared to those receiving DPP-4i. Hence, GLP-1RA may improve stroke outcomes in comparison with DPP-4i.
Key numbers
2.4%
Absolute Risk of Very Severe Stroke
Absolute risk in GLP-1RA users compared to DPP-4i users.
3.9%
30-Day Mortality Rate
Mortality rate for GLP-1RA users compared to 10.0% for DPP-4i users.
0.49
Adjusted Risk Ratio for Very Severe Stroke
Adjusted risk ratio for GLP-1RA vs. DPP-4i users.
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The authors declare the funding as a potential conflict of interest. However, Novo Nordisk Denmark A/S had no influence on data collection, no data access, and no influence on the interpretation of the results.
