Key result
GLP-1 RAs reduce total stroke risk by ~15% vs. placebo.
Why the study?
Despite improving outcomes in diabetes mellitus or obesity, GLP-1 receptor agonists remain underutilized, prompting an investigation into their impact on stroke risk to optimize clinical implementation.
Do GLP-1 RAs reduce the risk of stroke in individuals with or without type 2 diabetes compared to placebo?
Meta-Analysis (n=82,140)
Do GLP-1 RAs reduce the risk of stroke in individuals with or without type 2 diabetes compared to placebo?
GLP-1 RAs significantly reduce the risk of total and non-fatal strokes by approximately 15% compared to placebo in patients with or without type 2 diabetes.
Answers are grounded in this paper and cite their sources.
GLP-1 RAs reduce stroke risk regardless of diabetes status; confirms benefit and supports broader prevention use.
BACKGROUND: In patients surviving stroke, approximately 15% and 60% exhibit concurrent diabetes mellitus and overweight/obesity, respectively, necessitating heightened secondary prevention efforts. Despite glucagon-like peptide-1 receptor agonists (GLP-1 RAs) demonstrating improved outcomes for those with diabetes mellitus or obesity, their underutilization persists among eligible individuals. This systematic review and meta-analysis investigated the impact of GLP-1 RAs on stroke risk. The findings aim to optimize the implementation of this therapeutic strategy in patients surviving stroke with diabetes mellitus or obesity. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we systematically reviewed MEDLINE and Scopus until 15 November 2023. Eligible studies included randomized cardiovascular outcome trials (CVOTs) with individuals, with or without type 2 diabetes, randomized to either GLP-1 RA or placebo. The outcomes were total strokes, non-fatal strokes, and fatal strokes. Analyses were conducted using RevMan 5.4.1. RESULTS: Among 1369 screened studies, 11 were eligible, encompassing 82,140 participants (34.6% women) with a cumulative follow-up of 247,596 person-years. In the GLP-1 RAs group, the stroke rate was significantly lower compared to placebo (RR: 0.85, 95% CI: 0.77-0.93; NNT: 200), showing no heterogeneity or interaction with administration frequency (daily vs weekly). In addition, the GLP-1 RAs group exhibited a significantly lower rate of non-fatal strokes compared to placebo (RR: 0.87, 95% CI: 0.79-0.95; NNT: 250), with no heterogeneity or interaction based on administration frequency, route (oral vs subcutaneous), or diabetes presence. CONCLUSION: In this meta-analysis of 11 CVOTs with 82,140 participants, GLP-1 RAs demonstrated a 16% relative reduction in stroke risk compared to placebo. This finding may increase implementation of GLP-1 RAs by stroke specialists in individuals with stroke and comorbid diabetes mellitus or obesity. DATA ACCESS STATEMENT: The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Adamou et al. (2024) conducted a meta-analysis in Individuals with or without type 2 diabetes (n=82,140). Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) vs. Placebo was evaluated on Total strokes (RR 0.85, 95% CI 0.77-0.93). Glucagon-like peptide-1 receptor agonists significantly reduced the risk of total strokes compared to placebo (RR 0.85; 95% CI 0.77-0.93).
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