A recent study presented at the American Heart Association’s Scientific Sessions 2024 indicates that GLP-1 receptor agonists and SGLT2 inhibitors may significantly decrease the risk of heart attacks, recurrent strokes, and mortality in individuals who have previously experienced an ischemic stroke. The research, conducted by a team at the Mayo Clinic in Rochester, Minnesota, suggests new avenues for preventing subsequent cardiovascular events in stroke survivors using drugs commonly prescribed for diabetes and weight loss.
Reduced Risk of Cardiovascular Events
The Mayo Clinic researchers analyzed health data from 7,044 adults who had suffered ischemic strokes between 2000 and 2022, sourced from the Rochester Epidemiology Project. The study focused on the impact of GLP-1 medications (such as liraglutide, semaglutide, or tirzepatide) and SGLT2 inhibitors (including canagliflozin, dapagliflozin, and empagliflozin) on the rates of second strokes, heart attacks, and death.
After a three-year average follow-up, the study revealed that adults taking either a GLP-1 receptor agonist or an SGLT2 inhibitor experienced a 74% reduction in the risk of death and an 84% reduction in the risk of heart attack. While the overall risk of recurrent stroke was not significantly reduced, those taking SGLT2 inhibitors showed a 67% lower risk of experiencing another stroke. The mortality rate among stroke survivors using these medications was 11.8%, compared to 54% for those not taking them. Heart attack rates were also notably lower in the treatment group, with only 1.5% experiencing a heart attack, versus 6.1% in the non-treatment group.
Expert Commentary and Potential Mechanisms
M. Ali Sheffeh, MD, the lead study author and internal medicine physician at the Mayo Clinic, emphasized the importance of managing cardiovascular risks in stroke survivors, noting that "a quarter of people who survive a stroke will have another stroke, and they are also at risk for other cardiovascular events such as a heart attack."
Cheryl Bushnell, MD, a neurology professor at Wake Forest University, noted that randomized controlled trials have shown the ability of SGLT2 inhibitors and GLP-1 receptor agonists to reduce the risk of cardiovascular disease, including stroke, heart attack, and death. Bushnell also pointed out that GLP-1 receptor agonists can lower blood pressure and reduce plaque formation in blood vessels, further supporting their potential cardiovascular benefits for stroke survivors. "Another mechanism that could be very important for this current study is that GLP-1 receptor agonists can actually decrease clumping of blood platelets, and that, in itself, could decrease the risk of clotting and lead to a lower risk of stroke," Bushnell said.
GLP-1 Receptor Agonists and Venous Thromboembolism
New data from a study of more than 650,000 patients with type 2 diabetes suggests use of GLP-1 receptor agonists (GLP-1 RA), like semaglutide, could reduce stroke risk. The propensity-score matched analysis, which was presented at the 66th American Society of Hematology (ASH) Annual Meeting and Exposition, compared the effects of GLP-1 RA use relative to DPP-4 inhibitor, another antihyperglycemic agent, and concluded use of GLP-1 RAs was associated with an 18% reduction in risk of venous thromboembolism.
Limitations and Future Directions
The Mayo Clinic researchers acknowledged limitations, including the study's focus on a predominantly white population within a single health system, which may limit the generalizability of the findings. The study also did not determine the reasons for prescribing these medications or assess the severity of the strokes experienced by patients, which could have influenced outcomes.
Despite these limitations, the findings suggest the potential to influence clinical practice, especially given the increasing use of GLP-1 receptor agonists and SGLT2 inhibitors for type 2 diabetes management and weight loss. Further clinical trials are needed to confirm these findings and determine how these medications can be best used to prevent recurrent strokes and other cardiovascular events.
