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Stroke risk in diabetic patients with concomitant cardiovascular disease the CARDIAB-Stroke study

Ziad Arow1, Tzipi Hornik-Lurie2, Ranin Hilu3

  • 1Groupe CardioVasculaire Intervetionnel, Clinique Pasteur, Toulouse, France. 45 Avenue de Lombez, 31076 Toulouse, France; Cardiology Department, Meir Medical Center, Tel-Aviv University, Israel. 59 Tchernichovsky Street Kfar Saba 44281, Israel.

Annales D'Endocrinologie
|August 17, 2026
PubMed

Insights

Patients with type 2 diabetes and cardiovascular disease face high stroke risk. Using SGLT2 inhibitors and GLP-1 receptor agonists significantly reduces this risk, especially when combined.

Area of Science:

  • Cardiology
  • Endocrinology
  • Public Health

Background:

  • Patients with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD) have a high risk of stroke and transient ischemic attack (TIA).
  • Many high-risk patients remain undertreated with cardioprotective therapies, necessitating further investigation into risk factors and effective treatments.
  • Sodium-glucose cotransporter-2 inhibitors (SGLT2-I) and glucagon-like peptide-1 receptor agonists (GLP-1RA) are emerging as potentially cardioprotective agents.

Purpose of the Study:

  • To assess the stroke and transient ischemic attack (TIA) risk in patients with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD).
  • To identify predictors of stroke and TIA in this high-risk population.
  • To evaluate the impact of sodium-glucose cotransporter-2 inhibitors (SGLT2-I) and glucagon-like peptide-1 receptor agonists (GLP-1RA) on stroke and TIA outcomes.

Main Methods:

  • Utilized the nationwide CARdiovascular and DIABetes (CARDIAB) cohort, including patients with T2DM and ASCVD.
  • Analyzed stroke predictors and the associations between SGLT2-I and GLP-1RA use and clinical outcomes.
  • Followed 138,397 patients for a median of 5.5 years, recording stroke or TIA events.

Main Results:

  • Overall, 20.7% of patients experienced stroke or TIA during the follow-up period.
  • Predictors of increased risk included smoking, prior stroke/TIA, chronic kidney disease, older age, male sex, and Arab ethnicity.
  • Treatment with SGLT2-I and GLP-1RA, particularly in combination, was associated with significantly reduced event rates (HR 0.78 for combined use), indicating a 22% relative risk reduction.

Conclusions:

  • Patients with T2DM and ASCVD exhibit a markedly elevated risk of stroke.
  • The use of SGLT2-I and GLP-1RA is associated with a significant reduction in stroke risk, with combined therapy showing the greatest benefit.
  • Increased adoption of SGLT2-I and GLP-1RA, alongside comprehensive risk factor management, is crucial for mitigating stroke burden in this vulnerable population.
Abstract

Keywords:
GLP-1RASGLT2-IStrokeTIAType 2 diabetes mellitus

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