Association between glucagon-like peptide-1 receptor agonist use and ischemic stroke severity

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduce stroke incidence, but their impact on the severity of acute ischemic stroke (AIS) when events occur remains unclear. The aim of this study is to evaluate whether pre-stroke GLP-1RA use is associated with reduced ischemic stroke severity and improved post-stroke outcomes.

We conducted a retrospective cohort study using the 2016-2024 data from the TriNetX US Collaborative Network. Patients were categorized based on documented use of GLP-1RAs for at least six months prior to the index stroke event. After, propensity score matching, primary outcome was measured by the National Institutes of Health Stroke Scale (NIHSS), with secondary outcomes including rates of severe stroke (NIHSS ≥10), intensive care unit admission, neurological symptoms, in-hospital complications, and 30-day mortality.

A total of 209,180 first-time AIS patients were identified, of whom 4773 (2.3%) were GLP-1RA users. After PSM, 4769 patients remained in each group. GLP-1RA users had lower median NIHSS (3 vs 4, p < 0.001). GLP-1RA users also had lower rates of severe stroke (18.4% vs 25.5%, p < 0.001), dysphagia/dysarthria (43.5% vs 48.0%, p < 0.001), aphasia (25.2% vs 28.7%, p < 0.001), hemiplegia/hemiparesis (37.6% vs 43.3%, p < 0.001), intracranial hemorrhage (13.2% vs 14.7%, p = 0.031), and 30-day mortality (6.3% vs 7.6%, p = 0.016).

Among adult patients who suffered a first-time AIS, pre-stroke use of GLP-1RA was associated with reduced stroke severity, lower rates of symptoms and complications, and lower mortality. These findings suggest that the benefits GLP-1RA may extend beyond preventing the occurrence of cerebrovascular events.