Key Takeaways:
- The use of SGLT2 inhibitors or GLP-1 receptor agonists after a stroke may reduce the risk of cardiovascular (CV) events, including heart attacks, and improve overall mortality.
- The impact of these medications on the risk of recurrent stroke showed mixed results depending on the type of analysis.
SGLT2 inhibitors and GLP-1 receptor agonists, when used post-stroke, may significantly lower the risk of death and subsequent cardiovascular events, according to research presented at the American Heart Association Scientific Sessions.
Dr. Mohammad Ali Sheffeh, an internal medicine physician and research scholar at Mayo Clinic, explained the significance of this study:
“Patients who have had a stroke are at a higher risk of experiencing another stroke, heart attack, or death. Current guidelines recommend lifestyle changes, blood thinners, cholesterol-lowering medications, and managing other risk factors like diabetes, hypertension, and smoking to reduce these risks. However, despite these measures, recurrent adverse events still occur. Since SGLT2 inhibitors and GLP-1 receptor agonists have shown favorable outcomes in patients with diabetes, obesity, heart failure, and kidney disease, we investigated their effectiveness in reducing risks among stroke patients.”
Study Overview:
Using data from the Rochester Epidemiology Project, researchers analyzed 7,044 adults admitted for acute ischemic stroke between 2000 and June 2022 (mean age: 72 years; 52% men; 94% white). SGLT2 or GLP-1 exposure was defined as treatment with either medication after the index stroke.
Outcomes Measured:
- Primary Outcome: All-cause mortality.
- Secondary Outcomes: Recurrent ischemic stroke, myocardial infarction (MI), and a composite of these events.
Results:
Over a median follow-up of three years:
- 6% of patients experienced a second stroke.
- 6% experienced an MI.
- 53% died.
Key Findings (Univariate Analysis):
- All-cause mortality: HR = 0.26; 95% CI, 0.17-0.39; P < .0001.
- MI: HR = 0.16; 95% CI, 0.05-0.31; P = .00054.
- Composite outcome: HR = 0.34; 95% CI, 0.42-0.47; P < .0001.
These associations remained significant after adjusting for confounders and were unaffected by minimum exposure times for SGLT2 inhibitors or GLP-1 receptor agonists.
Recurrent Stroke Analysis:
- Risk of recurrent stroke was reduced by 67% among patients treated with SGLT2 inhibitors alone compared with untreated patients.
- No significant difference was found in recurrent stroke risk between those taking GLP-1 receptor agonists alone and untreated patients.
Subanalysis Findings:
- SGLT2 inhibitors consistently showed protective effects, but GLP-1 receptor agonists alone did not demonstrate significant benefits for recurrent stroke, possibly due to a smaller sample size.
- Very few patients were using both medications simultaneously, limiting analysis on combined effects.
Implications:
“Our findings align with prior studies highlighting the cardiovascular benefits of SGLT2 inhibitors and GLP-1 receptor agonists,” Dr. Sheffeh noted. “If validated through further research and clinical trials, these results could lead to changes in practice to better reduce adverse outcomes for stroke patients.”
Limitations:
The study design did not allow for identification of specific GLP-1 receptor agonists used by individual patients, which may have influenced the results.
Source:
Sheffeh MA, et al. Abstract 4148007. Presented at the American Heart Association Scientific Sessions, Nov. 16-18, 2024, Chicago.
Disclosures:
The authors reported no relevant financial disclosures.
