GLP-1 receptor agonists lower risks for nonfatal, total stroke in type 2 diabetes
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Researchers found evidence that GLP-1 receptor agonists, but not SGLT2 inhibitors or DPP-IV inhibitors, may help prevent stroke for individuals with type 2 diabetes, according to results of a meta-analysis.
“In recent years, new glucose-lowering drugs, such as SGLT-2 inhibitors, GLP-1 agonists and DPP-IV inhibitors, have been proved not to increase the risk of major adverse cardiovascular events, and may have a potential cerebrovascular event benefit,” Jiaxi Li, MD, from the School of Basic Medicine and Clinical Pharmacy at China Pharmaceutical University and the department of pharmacy at the Affiliated Drum Tower Hospital at the Medical School of Nanjing University, China, and colleagues wrote. “However, which class of new hypoglycemic drugs has a greater effect on cerebrovascular events, no direct studies are comparing the effect of the three classes of glucose-lowering drugs on stroke events.”
Through a search of Embase, Cochrane Library and PubMed databases, researchers identified 19 randomized controlled trials with stroke as an outcome event. All studies were published before December 2021 and consisted of 155,027 participants with type 2 diabetes (66.5% men) with median follow-up of 1.3 to 10.5 years.
Overall, the percentage of participants with a history of stroke between all 19 studies ranged from 5.5% to 22.4%. Compared with placebo, GLP-1 agonists reduced nonfatal stroke risk by 15% (RR = 0.85; 95% CI, 0.77-0.94; P = .002) in the pooled analysis. Among the 16 randomized controlled trials included that demonstrated the effect of new glucose-lowering drugs on nonfatal strokes, GLP-1 agonists lowered the total stroke risk by 16% (RR = 0.84; 95% CI, 0.77-0.94; P < .001).
In addition, both SGLT2 inhibitors and DPP-IV inhibitors demonstrated no significant associations with nonfatal stroke or total stroke.
According to the researchers, other randomized controlled studies have demonstrated that SGLT2 inhibitors have a beneficial effect on hemorrhagic stroke, possibly related to the hypotensive and hypolipidemic effects.
The sensitivity analysis demonstrated no significant impact on results even after excluding any of the 19 randomized controlled trials, the researchers wrote.
“In a word, our pooled analysis of currently published randomized controlled trials suggests that SGLT2 inhibitors do not increase the risk of stroke and that more studies are needed in the future to explore the effect on different stroke types,” the researchers wrote.
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