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March 16, 2025IJC Heart & VasculatureOpen Access

Efficacy of glucagon-like peptide-1 receptor agonists for prevention of stroke among patients with and without diabetes: A meta-analysis with the SELECT and FLOW trails

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Key result

GLP-1 receptor agonists significantly reduced the risk of stroke by 15% (OR 0.85) compared with placebo in patients with and without diabetes.

Why the study?

GLP-1 receptor agonists reduce major adverse cardiovascular events in type 2 diabetes mellitus, but their efficacy on cerebrovascular events across patients with and without diabetes is not well established.

Do GLP-1 receptor agonists reduce the risk of stroke in patients with and without diabetes?

Population

85,373 patients with and without diabetes across 11 RCTs

Comparison

GLP-1 receptor agonists vs placebo

Design

Meta-analysis of randomized controlled trials

Authors

AGAsmita GeraFLFakhar LatifVBVamsikalyan Borra

Discussion

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Overview

GLP-1RAs reduce stroke risk regardless of diabetes status; extends prior evidence to non-diabetic populations.

Study Design

Type

Meta-Analysis (n=85,373)

Structured PICO

Do GLP-1 receptor agonists reduce the risk of stroke in patients with and without diabetes?

P
Population
85,373 adults with and without diabetes from 11 randomized controlled trials, followed for a median of 2.1 years to evaluate the efficacy of GLP-1 receptor agonists on stroke risk.
I
Intervention
GLP-1 receptor agonists as a class (including semaglutide, exenatide, albiglutide, dulaglutide, lixisenatide, liraglutide, efpeglenatide)
C
Comparator
Placebo
O
Outcome
Incidence of strokehard clinical

Main Result

Odds Ratio: 0.85 (95% CI 0.77–0.93)

p-value: p=< 0.001

GLP-1 receptor agonists significantly reduce the risk of overall and nonfatal stroke in patients with and without diabetes, without increasing stroke-related adverse events.

Limitations

  • Included studies lacked specific data on the recurrence of stroke or mortality following a stroke.
  • Failed to incorporate disabling stroke as an outcome due to absence of specific data.
  • Did not perform subgroup analyses based on prior history of stroke or important risk factors for stroke, such as age.
  • Some outcomes were non-significant, which may reflect either a true lack of effect or insufficient statistical power.
  • Failed to take into account the impact of eGFR on the efficacy of GLP-1RA.
  • Lacked specific data on the recurrence of stroke or mortality following a stroke
  • Failed to incorporate disabling stroke as an outcome
  • Did not perform subgroup analyses based on prior history of stroke or important risk factors for stroke, such as age
  • Some outcomes were non-significant, which may reflect insufficient statistical power
  • Failed to take into account the impact of eGFR on the efficacy of GLP-1RA

Cite This Study

Gera et al. (2025) conducted a meta-analysis in Patients with and without diabetes (n=85,373). Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) vs. Placebo was evaluated on Incidence of stroke (OR 0.85, 95% CI 0.77 - 0.93, p=< 0.001). GLP-1 receptor agonists significantly reduced the risk of stroke by 15% (OR 0.85) compared with placebo in patients with and without diabetes.

synapsesocial.com/papers/6a790bc970e13102dc674079https://doi.org/10.1016/j.ijcha.2025.101638
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