Pasi Marco, Bretonnière Arnaud, Lochon Lisa, Dosda Arnaud, Bisson Arnaud, Boulouis Grégoire, Ducluzeau Pierre Henri, Fauchier Laurent
Neurology Department, CIC-IT 1415, INSERM 1253 iBrain (M.P., A. Bretonnière), Centre Hospitalier Universitaire de Tours, Université de Tours, France.
Department of Internal Medicine, Endocrinology, Diabetology, and Nutrition (L.L., A.D., P.H.D.), Centre Hospitalier Universitaire de Tours, Université de Tours, France.
Stroke. 2025 Sep;56(9):2761-2766. doi: 10.1161/STROKEAHA.125.050972. Epub 2025 Jun 5.
GLP-1RAs (glucagon-like peptide-1 receptor agonists) have consistently demonstrated a protective effect against ischemic stroke. However, whether this benefit also extends to nontraumatic intracerebral hemorrhage (ICH) remains unknown. Given the blood pressure-lowering and anti-inflammatory properties of GLP-1RAs, we aimed to evaluate their potential impact on ICH risk in patients with type 2 diabetes.
We conducted a retrospective cohort study using global health care data from the TriNetX network. Patients with type 2 diabetes who used GLP-1RAs (n=326 777) were compared with those who did not (n=643 614). Propensity score matching (1:1) was performed to balance baseline characteristics, and follow-up was conducted for up to 4 years. The primary outcomes included all-cause mortality, ischemic stroke, and ICH (overall and by location). Hazard ratios and 95% CIs were calculated to assess the mean treatment effect in the treated group.
After propensity score matching (resulting in 2 balanced groups of 255 460 individuals each), GLP-1RAs use was associated with a lower risk of ICH (hazard ratio, 0.743 [95% CI, 0.684-0.807]). The lower ICH risk associated with GLP-1RAs was observed across all ICH locations (all ≤0.01). In addition, exposure to GLP-1RAs was associated with a significantly lower rate of mortality (hazard ratio, 0.525 [95% CI, 0.512-0.538]) and ischemic stroke (hazard ratio, 0.871 [95% CI, 0.843-0.901]).
This study highlights a novel potential association between GLP-1RAs and a lower risk of ICH in patients with type 2 diabetes. Prospective studies and future trials are needed to confirm the potential protective effect of GLP-1RAs on small vessel rupture.
胰高血糖素样肽-1受体激动剂（GLP-1RAs）一直显示出对缺血性中风的保护作用。然而，这种益处是否也适用于非创伤性脑出血（ICH）仍不清楚。鉴于GLP-1RAs的降压和抗炎特性，我们旨在评估其对2型糖尿病患者ICH风险的潜在影响。
我们使用来自TriNetX网络的全球医疗保健数据进行了一项回顾性队列研究。将使用GLP-1RAs的2型糖尿病患者（n = 326777）与未使用的患者（n = 643614）进行比较。进行倾向评分匹配（1:1）以平衡基线特征，并进行长达4年的随访。主要结局包括全因死亡率、缺血性中风和ICH（总体及按部位）。计算风险比和95%置信区间以评估治疗组的平均治疗效果。
倾向评分匹配后（形成每组255460人的两个平衡组），使用GLP-1RAs与较低的ICH风险相关（风险比，0.743 [95%置信区间，0.684 - 0.807]）。在所有ICH部位均观察到与GLP-1RAs相关的较低ICH风险（均≤0.01）。此外，使用GLP-1RAs与显著较低的死亡率（风险比，0.525 [95%置信区间，0.512 - 0.538]）和缺血性中风发生率（风险比，0.871 [95%置信区间，0.843 - 0.901]）相关。
本研究突出了GLP-1RAs与2型糖尿病患者较低ICH风险之间的一种新的潜在关联。需要进行前瞻性研究和未来试验以证实GLP-1RAs对小血管破裂的潜在保护作用。
