Yeh Jun-Jun, Li Chih-Chien, Tan Chang-Wen, Li Chia-Hsun, Tsai Tung-Han, Kao Chia-Hung
Department of Thoracic Medicine, Family Medicine, Geriatric Medicine and Medical Research, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi 600, Taiwan.
Department of Psychotherapy, Clinical Psychology Center, Chia-Yi Christian Hospital, Chia-Yi 600, Taiwan.
Biomedicines. 2024 Feb 22;12(3):488. doi: 10.3390/biomedicines12030488.
The purpose of this paper is to assess the effect of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on stroke or heart disease in patients having chronic respiratory disease and diabetes (CD) with underlying diseases related to COVID-19. From 1998 to 2019, we adjusted competing risk by assessing the effect of GLP-1RAs on stroke or heart disease in a CD cohort after propensity matching based on the Taiwan National Health Insurance Research Database. We also used the time-dependent method to examine the results. GLP-1 RA and non-GLP-1 RA user groups included 15,801 patients (53% women and 46% men with a mean age of 52.6 ± 12.8 years). The time between the diagnoses of DM and the initial use of the GLP-1 RA among the stroke subcohort (<2000 days) was shorter than that of the heart disease subcohort (>2000 days) (all -values < 0.05). The overall risks of stroke, ischemic, and hemorrhagic stroke were significantly lower in GLP-1 RA users than nonusers. The adjusted subhazard ratio (aSHR) was 0.76 [95% CI 0.65-0.90], 0.77 [95% CI 0.64-0.92], and 0.69 [95% CI 0.54-0.88] ( < 0.05 for all). Furthermore, a ≥351-day use had a significantly lower stroke risk than GLP-1 RA nonusers (aSHR 0.35 [95% CI 0.26-0.49]). The time-dependent method revealed the same result, such as lower stroke, and ischemic or hemorrhagic stroke risk. In contrast, the cardiac arrhythmia incidence was higher in GLP-1 RA users with an aSHR of 1.36 [95% CI 1.16-1.59]. However, this risk disappeared after the ≥351-day use with 1.21 (0.98, 1.68) aSHR. Longer GLP-1 RA use was associated with a decreased risk of ischemic or hemorrhagic stroke and the risk of cardiac arrhythmia disappears in a CD cohort. Both a shorter lag time use of the GLP-1 RA and a longer time use of GLP-1 RA were associated with a decreased risk of ischemic or hemorrhagic stroke in the CD cohort. The GLP-1 RA use in the early stage and optimal time use in the CD cohort may avoid the stroke risk.
本文旨在评估胰高血糖素样肽-1受体激动剂（GLP-1RAs）对患有慢性呼吸道疾病和糖尿病（CD）且伴有与COVID-19相关基础疾病的患者发生中风或心脏病的影响。1998年至2019年期间，我们基于台湾国民健康保险研究数据库，通过倾向匹配后评估GLP-1RAs对CD队列中中风或心脏病的影响来调整竞争风险。我们还采用时间依赖性方法来检验结果。GLP-1 RA使用者组和非GLP-1 RA使用者组包括15801名患者（53%为女性，46%为男性，平均年龄52.6±12.8岁）。中风亚组中糖尿病诊断与首次使用GLP-1 RA之间的时间（<2000天）短于心脏病亚组（>2000天）（所有P值<0.05）。GLP-1 RA使用者的中风、缺血性中风和出血性中风的总体风险显著低于非使用者。调整后的亚风险比（aSHR）分别为0.76 [95%置信区间0.65 - 0.90]、0.77 [95%置信区间0.64 - 0.92]和0.69 [95%置信区间0.54 - 0.88]（所有P<0.05）。此外，使用GLP-1 RA≥351天的患者中风风险显著低于非使用者（aSHR 0.35 [95%置信区间0.26 - 0.49]）。时间依赖性方法得出了相同的结果，即中风、缺血性或出血性中风风险较低。相比之下，GLP-1 RA使用者的心律失常发生率较高，aSHR为1.36 [95%置信区间1.16 - 1.59]。然而，在使用≥351天后，这种风险消失，aSHR为1.21（0.98，1.68）。在CD队列中，较长时间使用GLP-1 RA与缺血性或出血性中风风险降低相关，且心律失常风险消失。在CD队列中，GLP-1 RA使用的滞后时间较短和使用时间较长均与缺血性或出血性中风风险降低相关。在CD队列中早期使用GLP-1 RA以及最佳时间使用GLP-1 RA可能避免中风风险。
