From the Guidelines
GLP-1 receptor agonists, such as exenatide, liraglutide, and semaglutide, do not increase the risk of stroke in patients with type 2 diabetes, and may actually reduce stroke risk in many patients. The most recent and highest quality study, the LEADER trial 1, demonstrated that liraglutide reduced the risk of major cardiovascular events, including stroke, compared to placebo. Similarly, the SUSTAIN-6 trial 1 showed that semaglutide was associated with a significant reduction in stroke risk. These medications work by improving glycemic control, promoting weight loss, reducing blood pressure, and potentially having direct beneficial effects on blood vessels and inflammation, all of which contribute to lower stroke risk.
Some of the key benefits of GLP-1 receptor agonists include:
- Improved glycemic control
- Weight loss
- Reduced blood pressure
- Potential direct beneficial effects on blood vessels and inflammation
- Reduced risk of major adverse cardiovascular events, including stroke
The evidence from multiple studies, including the LEADER trial 1, SUSTAIN-6 trial 1, and others 1, consistently shows that GLP-1 receptor agonists do not increase the risk of stroke and may actually reduce stroke risk in patients with type 2 diabetes. Therefore, GLP-1 receptor agonists can be a valuable treatment option for patients with type 2 diabetes, particularly those with established cardiovascular disease or multiple risk factors. However, individual patient factors should always be considered, and these medications should be used as part of a comprehensive treatment approach that includes lifestyle modifications and management of other cardiovascular risk factors such as hypertension and dyslipidemia.
From the Research
GLP-1 Receptor Agonists and Stroke Risk
- The relationship between GLP-1 receptor agonists and stroke risk in patients with type 2 diabetes has been investigated in several studies 2, 3.
- According to a 2021 study published in Molecular Metabolism, GLP-1 receptor agonists have been shown to effectively prevent cardiovascular events, including stroke, in patients with pre-existing atherosclerotic vascular disease 2.
- Another study published in The Lancet in 2021 found that GLP-1 receptor agonists confer protection against major cardiovascular disease, including stroke, in patients with established atherosclerotic cardiovascular disease 3.
- However, the evidence for the effect of GLP-1 receptor agonists on stroke risk in lower-risk subjects is not as strong 2.
- Other studies have focused on the efficacy and safety of individual GLP-1 receptor agonists, such as exenatide, liraglutide, and semaglutide, but have not specifically addressed the risk of stroke 4, 5, 6.
Key Findings
- GLP-1 receptor agonists have been shown to reduce the risk of cardiovascular events, including stroke, in patients with pre-existing atherosclerotic vascular disease 2, 3.
- The evidence for the effect of GLP-1 receptor agonists on stroke risk in lower-risk subjects is limited 2.
- Individual GLP-1 receptor agonists may have different efficacy and safety profiles, but all have been shown to be effective in reducing A1C and weight in patients with type 2 diabetes 4, 5, 6.
GLP-1 Receptor Agonists and Cardiovascular Risk
- GLP-1 receptor agonists have been shown to have cardiovascular benefits, including reducing the risk of major cardiovascular events, such as stroke 2, 3.
- The cardiovascular benefits of GLP-1 receptor agonists are thought to be due to their effects on glucose-dependent insulin secretion, weight loss, and blood pressure reduction 3.
- However, the exact mechanisms by which GLP-1 receptor agonists reduce cardiovascular risk are not fully understood and require further study 2, 3.