Adamou Anastasia, Barkas Fotios, Milionis Haralampos, Ntaios George
Department of Internal Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
First Department of Propaedeutic Internal Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
Int J Stroke. 2024 Oct;19(8):876-887. doi: 10.1177/17474930241253988. Epub 2024 May 21.
In patients surviving stroke, approximately 15% and 60% exhibit concurrent diabetes mellitus and overweight/obesity, respectively, necessitating heightened secondary prevention efforts. Despite glucagon-like peptide-1 receptor agonists (GLP-1 RAs) demonstrating improved outcomes for those with diabetes mellitus or obesity, their underutilization persists among eligible individuals. This systematic review and meta-analysis investigated the impact of GLP-1 RAs on stroke risk. The findings aim to optimize the implementation of this therapeutic strategy in patients surviving stroke with diabetes mellitus or obesity.
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we systematically reviewed MEDLINE and Scopus until 15 November 2023. Eligible studies included randomized cardiovascular outcome trials (CVOTs) with individuals, with or without type 2 diabetes, randomized to either GLP-1 RA or placebo. The outcomes were total strokes, non-fatal strokes, and fatal strokes. Analyses were conducted using RevMan 5.4.1.
Among 1369 screened studies, 11 were eligible, encompassing 82,140 participants (34.6% women) with a cumulative follow-up of 247,596 person-years. In the GLP-1 RAs group, the stroke rate was significantly lower compared to placebo (RR: 0.85, 95% CI: 0.77-0.93; NNT: 200), showing no heterogeneity or interaction with administration frequency (daily vs weekly). In addition, the GLP-1 RAs group exhibited a significantly lower rate of non-fatal strokes compared to placebo (RR: 0.87, 95% CI: 0.79-0.95; NNT: 250), with no heterogeneity or interaction based on administration frequency, route (oral vs subcutaneous), or diabetes presence.
In this meta-analysis of 11 CVOTs with 82,140 participants, GLP-1 RAs demonstrated a 16% relative reduction in stroke risk compared to placebo. This finding may increase implementation of GLP-1 RAs by stroke specialists in individuals with stroke and comorbid diabetes mellitus or obesity.
The data that support the findings of this study are available from the corresponding author upon reasonable request.
在中风幸存者中，分别约有15%和60%的人同时患有糖尿病和超重/肥胖症，因此需要加强二级预防措施。尽管胰高血糖素样肽-1受体激动剂（GLP-1 RAs）已证明对糖尿病或肥胖症患者有更好的治疗效果，但在符合条件的人群中，其使用率仍然较低。本系统评价和荟萃分析研究了GLP-1 RAs对中风风险的影响。研究结果旨在优化这一治疗策略在糖尿病或肥胖症中风幸存者中的应用。
按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，我们系统检索了截至2023年11月15日的MEDLINE和Scopus数据库。符合条件的研究包括随机心血管结局试验（CVOTs），研究对象为患有或未患有2型糖尿病的个体，随机分为GLP-1 RA组或安慰剂组。结局指标为总中风、非致命性中风和致命性中风。使用RevMan 5.4.1进行分析。
在1369项筛选研究中，11项符合条件，涉及82140名参与者（34.6%为女性），累计随访2475年。在GLP-1 RAs组中，中风发生率显著低于安慰剂组（RR：0.85，95%CI：0.77-0.93；NNT：200），未显示出异质性或与给药频率（每日或每周）的相互作用。此外，与安慰剂组相比，GLP-1 RAs组的非致命性中风发生率显著更低（RR：0.87，95%CI：0.79-0.95；NNT：250），在给药频率、给药途径（口服或皮下）或是否患有糖尿病方面均未显示出异质性或相互作用。
在这项对11项CVOTs、82140名参与者的荟萃分析中，与安慰剂相比，GLP-1 RAs使中风风险相对降低了16%。这一发现可能会增加中风专科医生对中风合并糖尿病或肥胖症患者使用GLP-1 RAs的比例。
支持本研究结果的数据可在合理要求下从相应作者处获得。
