Gera Asmita, Latif Fakhar, Borra Vamsikalyan, Naz Sidra, Mittal Vivek, Ayoobkhan Fathima Shehnaz, Kumar Tushar, Wajid Zarghoona, Deb Novonil, Prasad Tanisha, Mattumpuram Jishanth, Jaiswal Vikash
Department of Internal Medicine, Tianjin Medical University, Wuqing District, Tianjin 301700, China.
Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Int J Cardiol Heart Vasc. 2025 Mar 16;57:101638. doi: 10.1016/j.ijcha.2025.101638. eCollection 2025 Apr.
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown a reduction in major adverse cardiovascular events (MACE) among patients with type 2 diabetes mellitus (T2DM). However, its efficacy on cerebrovascular events is yet to be well established among diabetic and non diabetic patients.
We sought to evaluate the efficacy of GLP-1 RAs on stroke risk among its different types in patients with and without Diabetes.
We performed a systematic literature search on PubMed, EMBASE, and ClinicalTrials.gov for relevant randomized controlled trials (RCTs) from inspection until 15th July 2024, without any language restrictions. Odds ratios (OR) and 95 % confidence intervals (CI) were pooled using a random-effect model, and a p-value of < 0.05 was considered statistically significant.
A total of 11 RCTs with 85,373 patients were included (43,339 in GLP-1 RA and 42,034 in the placebo group) in the analysis. The mean age of the patients in GLP-1 RAs and the placebo groups was 63.5 and 63.1 years, respectively. Pooled analysis of primary and secondary endpoints showed that GLP-1 RAs significantly reduced the risk of incidence of stroke by 15 % (OR, 0.85(95 %CI: 0.77-0.93), < 0.001) and nonfatal stroke by 13 % (OR, 0.87(95 %CI: 0.79-0.95), < 0.001) compared with placebo. However, the risk of fatal stroke (OR, 0.94(95 %CI: 0.75-1.17), 0.56) was comparable between both groups of patients. Similarly, the risk of serious adverse events such as cerebrovascular accident (OR, 0.75(95 %CI: 0.57-1.00), 0.05), hemorrhagic stroke (OR, 0.82(95 %CI: 0.42-1.60), 0.57, and ischemic stroke (OR, 0.85(95 %CI: 0.64-1.13), 0.26) was comparable between GLP-1RAs and placebo.
Treatment with GLP-1 receptor agonists has beneficial effects in reducing the risk of stroke, and nonfatal stroke in patients with and without diabetes. However, no such effect was observed for fatal stroke.
胰高血糖素样肽-1受体激动剂（GLP-1 RAs）已显示可降低2型糖尿病（T2DM）患者的主要不良心血管事件（MACE）。然而，其对糖尿病和非糖尿病患者脑血管事件的疗效尚未完全明确。
我们试图评估GLP-1 RAs对糖尿病和非糖尿病患者不同类型中风风险的疗效。
我们在PubMed、EMBASE和ClinicalTrials.gov上进行了系统的文献检索，以查找截至2024年7月15日的相关随机对照试验（RCT），无任何语言限制。使用随机效应模型汇总比值比（OR）和95%置信区间（CI），p值<0.05被认为具有统计学意义。
分析共纳入11项RCT，85373例患者（GLP-1 RA组43339例，安慰剂组42034例）。GLP-1 RA组和安慰剂组患者的平均年龄分别为63.5岁和63.1岁。对主要和次要终点的汇总分析表明，与安慰剂相比，GLP-1 RAs显著降低了中风发生率15%（OR，0.85（95%CI：0.77-0.93），<0.001）和非致命性中风13%（OR，0.87（95%CI：0.79-0.95），<0.001）。然而，两组患者的致命性中风风险（OR，0.94（95%CI：0.75-1.17），0.56）相当。同样，GLP-1 RAs组和安慰剂组之间的严重不良事件风险，如脑血管意外（OR，0.75（95%CI：0.57-1.00），0.05）、出血性中风（OR，0.82（95%CI：0.42-1.60），0.57）和缺血性中风（OR，0.85（95%CI：0.64-1.13），0.26）相当。
使用GLP-1受体激动剂治疗对降低糖尿病和非糖尿病患者的中风风险及非致命性中风具有有益作用。然而，未观察到对致命性中风的此类作用。
