SGLT2s, GLP-1s may improve mortality, CV event risk after stroke
Click Here to Manage Email Alerts
Key takeaways:
- SGLT2 inhibitor/GLP-1 use after stroke may reduce risk for subsequent CV events and improve mortality.
- The drugs’ benefit on reducing risk for recurrent stroke varied in different analyses.
CHICAGO — Use of an SGLT2 inhibitor or GLP-1 receptor agonist after stroke may improve mortality and lower subsequent risk for heart attack and another stroke, a speaker reported.
Data from Mayo Clinic registry-based analysis to evaluate the impact of SGLT2 inhibitors or GLP-1 receptor agonists on CV event risk and mortality were presented at the American Heart Association Scientific Sessions.
“Patients who had a stroke are at increased risk of a second stroke, heart attack and death. In order to prevent these adverse outcomes, the current guidelines recommend lifestyle medication, blood thinner and cholesterol-lowering medications in addition to controlling other risk factors like diabetes, smoking and high BP,” Mohammad Ali Sheffeh, MD, internal medicine physician and research scholar at Mayo Clinic, told Healio. “Unfortunately, even with these preventive strategies, we still see patients having another stroke or heart attack. SGLT2 inhibitors and GLP-1 receptor agonist drugs have shown to have a better outcome in patients with diabetes, obesity, HF and kidney disease. We sought to evaluate their effectiveness in patients who had a stroke to lower their risks of future adverse events even more compared to the current practice.”
Sheffeh and colleagues used data from the Rochester Epidemiology Project to identify 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 drug after the index stroke.
The primary outcome was all-cause mortality, and the secondary outcomes included MI, recurrent ischemic stroke or a composite of the primary and secondary outcomes.
Over a median follow-up of 3 years, 6% of the cohort experienced a second stroke, 6% experienced an MI and 53% died, according to the presentation.
In the univariate analysis, SGLT2 inhibitor or GLP-1 receptor agonist use after first stroke was associated with lower risk for all-cause mortality (HR = 0.26; 95% CI, 0.17-0.39; P < .0001), incident MI (HR = 0.16; 95% CI, 0.05-0.31; P = .00054) and the composite outcome (HR = 0.34; 95% CI, 0.42-0.47; P < .0001). The reported associations remained significant after multivariable adjustment and were not affected by minimum SGLT2 or GLP-1 exposure time, according to the presentation.
“Our results are in line with prior findings of the protective role of either GLP-1 receptor agonists or SGLT2 inhibitors and their favorable CV outcomes including lowering the risk for heart attack and death. To my knowledge, no prior studies have evaluated their role in this high-risk population of patients with stroke,” Sheffeh told Healio. “We need to further validate and conduct clinical trials before we can recommend the use of these medications in patients with stroke. If these findings were extensively validated, this might lead in changing practice for helping our patients lowering their risk for future adverse events.”
In other findings, the risk for recurrent stroke was approximately 67% lower among patients treated with an SGLT2 inhibitor alone compared with no treatment. There was no significant difference in risk for recurrent stroke between patients who did or did not take either and SGLT2 inhibitor or and GLP-1 receptor agonist (P = .12); however, lower risk was observed in a multivariable analysis incorporating recurrent stroke risk factors including age, sex, hypertension status, diabetes status, peripheral artery disease and a history of MI or HF (P = .01).
“The results were very similar to the main analysis when conducting a subanalysis where we evaluated the effect of using SGLT2 alone or GLP-1. The only exception was that we did not find any differences in the risk of having another stroke between those who were taking GLP-1 receptor agonist alone and those who were not. This might be explained by a smaller sample size and, thus, decreasing the power of the analysis,” Sheffeh told Healio. “Of note, the main analysis was on patients who were taking either SGLT2 inhibitor or GLP-1 receptor agonist. Very few patients were actually taking both medications together at the same time.”
Due to study design, the researchers were unable to determine which GLP-1 receptor agonists were being used by specific patients, Sheffeh said.
Reference:
- GLP-1, SGLT2 medications may lower stroke survivor’s risk of future heart attack, stroke. https://newsroom.heart.org/news/glp-1-sglt2-medications-may-lower-stroke-survivors-risk-of-future-heart-attack-stroke. Published Nov. 11, 2024. Accessed Dec. 3, 2024.
Collapse
Sheffeh MA, et al. Abstract 4148007. Presented at: American Heart Association Scientific Sessions; Nov. 16-18, 2024; Chicago.
Click Here to Manage Email Alerts