In a preliminary study set to be presented at the American Heart Association’s Scientific Sessions 2024, a team of researchers from the Mayo Clinic in Rochester, Minnesota, found that GLP-1 receptor agonists and SGLT2 inhibitors may significantly reduce the risk of heart attacks, second strokes, and death in adults who have previously had an ischemic stroke. The findings could provide new insights into how these commonly prescribed diabetes and weight loss drugs could help prevent further cardiovascular events in stroke survivors.
“Unfortunately, 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,” said M. Ali Sheffeh, MD, lead study author and internal medicine physician at the Mayo Clinic. “Managing these risks, as well as looking at novel approaches to help lower the chances of another stroke, heart attack or death among this population are all critical steps in increasing stroke survival and improving the quality of life for people who have had a stroke.”
For this study, the Mayo Clinic researchers examined the health data of 7,044 adults who had suffered ischemic strokes between 2000 and 2022 whose records are in the Rochester Epidemiology Project. The database collects data from a collaboration of clinics, hospitals and other medical facilities including those in the Mayo Clinic, Olmstead Medical Center, Olmsted County Public Health Services or Zumbro Valley Health Center in Minnesota, as well as the Mayo Clinic Health system in Wisconsin.
The study specifically looked at whether the use of GLP-1 medications, like liraglutide, semaglutide, or tirzepatide, or SGLT2 inhibitors, such as canagliflozin, dapagliflozin, and empagliflozin, were associated with a decrease in the rates of second strokes, heart attacks, and death.
After an average follow-up of three years, the researchers found that adults who took either a GLP-1 or SGLT2 medication experienced a 74% lower risk of death and an 84% lower risk of having a heart attack. While the risk of having another stroke was not significantly reduced, adults who took SGLT2 inhibitors showed a 67% lower risk of having a second stroke. The death rate among stroke survivors who took either medication was just 11.8%, compared to 54% for those who did not. The rate of heart attacks was also substantially lower in the treatment group, with only 1.5% of patients who took the medications having a heart attack, compared to 6.1% among those who did not.
Despite these promising results, the researchers said this study drew people from a small geographic region from within a single health system and its participants were predominantly white, which could limit the ability to translate these findings to other geographies or ethnic groups. The study did not determine the reason patients were prescribed these medications and the severity of the strokes that patients experienced could not be assessed, which may have affected the outcomes.
Nevertheless, the findings show potential to inform clinical practice, given the increasing use of GLP-1 receptor agonists and SGLT2 inhibitors. Both classes of drugs have been widely prescribed for type 2 diabetes management and weight loss, and there is growing evidence to suggest they may have a role in preventing heart disease.
“For several years now, we have seen from randomized controlled trials that SGLT2 inhibitors and GLP-1 receptor agonists have the ability to reduce the risk of cardiovascular disease, which includes stroke, heart attack and death,” said Cheryl Bushnell, MD, a professor in the department of neurology at Wake Forest University. In addition, she noted that GLP-1 receptor agonists have also been shown to 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. “We need a clinical trial to know whether these SGLT2 inhibitors and GLP-1 receptor agonists could actually change practice, how we can help patients to prevent a second or recurrent stroke. These medications could be really important, however, we just don’t have that data yet.”
