Abstract 446: Impact of GLP‐1 Receptor Agonists After Mild Stroke in Obese Patients: A Multicenter Propensity Score‐Matched Analysis

Background Stroke is a major cause of disability and mortality globally, and obesity is a significant risk factor. Secondary prevention is vital for reducing the risk of recurrent strokes and improving outcomes. Glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) are promising for glycemic control and cardiovascular risk reduction. Earlier studies of GLP‐1RAs have shown a reduction in major adverse cardiovascular events but were not designed and powered to evaluate their specific impact on stroke outcomes. Thus, we aimed to investigate the impact of initiating GLP‐1RA treatment after a stroke on stroke‐related outcomes. Methods We conducted a retrospective cohort study using data from the TriNetX Research Network. Adult patients (≥18 years) with obesity and mild ischemic stroke (NIHSS 0‐8) were included. Patients who initiated GLP‐1RAs within one month post‐stroke were compared to non‐users. Propensity score matching (PSM) was applied to balance baseline characteristics. The primary outcome was recurrent stroke, with secondary outcomes including transient ischemic attack (TIA), hospital readmission, and imaging utilization within one year post‐stroke. Results A total of 246 patients who initiated GLP‐1RA were compared to 30,629 non‐users. After PSM, 243 patients were included in each cohort. GLP‐1RA users had a significantly lower risk of recurrent stroke (39.5% vs. 52.7%, RR 0.750, 95% CI 0.617‐0.912, p=0.004) and hospital readmission (20.2% vs. 30.5%, RR 0.662, 95% CI 0.484‐0.907, p=0.009). They also had reduced head CT/MRI imaging utilization (13.6% vs. 20.6%, RR 0.660, 95% CI 0.442‐0.987, p=0.040). No significant difference was observed in TIA incidence (6.6% vs. 7.0%, RR 0.941, 95% CI 0.487‐1.819, p=0.857). Conclusion GLP‐1RA therapy following mild ischemic stroke in obese patients was associated with a lower risk of recurrent stroke, hospital readmission, and imaging use. These findings support the potential role of GLP‐1RAs in secondary stroke prevention for this high‐risk population. Larger prospective studies are needed to confirm these results and guide clinical recommendations. image