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Stroke Prevention by Antihyperglycemic Drugs in Type 2 Diabetes Mellitus

Stewart G Albert1, Ekta Shrestha1, Vaishaliben Ahir1

  • 1Department of Internal Medicine, Division of Endocrinology, Saint Louis University School of Medicine, St Louis, Missouri.

Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
|December 14, 2023
PubMed

Insights

Glucagon-like peptide 1-receptor agonists (GLP-1RA) effectively prevent stroke in diabetic patients, unlike other glucose-lowering agents. Aggressive A1c reduction increases cardiovascular death risk, but GLP-1RA use shows stroke prevention benefits.

Area of Science:

  • Cardiology
  • Endocrinology
  • Neurology

Background:

  • Diabetes mellitus increases the risk of transient ischemic attacks/strokes (TIA/stroke) and major adverse cardiovascular events (MACE).
  • Guidelines recommend glucose-lowering agents (GLA) for TIA/stroke patients with diabetes to prevent MACE.
  • This review specifically evaluates differences in TIA/stroke prevention among various GLA classes.

Approach:

  • A systematic review and meta-analysis of previous studies were conducted.
  • Outcomes assessed included MACE, cardiovascular death (CVD), heart failure hospitalizations, and TIA/stroke.
  • GLA classes analyzed were GLP-1 receptor agonists (GLP-1RA), SGLT2 inhibitors (SGLT2i), insulin-providing regimens (IP), and thiazolidinediones (TZD).

Key Points:

  • GLP-1RA demonstrated a significant reduction in TIA/stroke risk (rr=0.840).
  • GLP-1RA and SGLT2i reduced cardiovascular deaths, while only SGLT2i significantly decreased heart failure hospitalizations.
  • Aggressive A1c lowering correlated with increased CVD risk, but GLP-1RA showed stroke prevention benefits without increased hypoglycemia.

Conclusions:

  • GLP-1RA use is associated with stroke prevention in diabetic patients with TIA/stroke history.
  • Both GLP-1RA and SGLT2i therapies contribute to reducing cardiovascular mortality.
  • Clinicians should balance A1c targets to avoid increased CVD risk associated with aggressive glucose lowering.
Abstract

Keywords:
GLP-1RAcardiovascular outcomesglucagon-like peptide 1-receptor agonistsmeta-analysisstroke

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