AHA 2024: GLP-1, SGLT2 Treatments May Lower Risk of Future Heart Attack, Stroke for Stroke Survivors

New data presented at the American Heart Association (AHA) 2024 Scientific Sessions suggest that stroke survivors taking either a glucagon-like peptide-1 (GLP-1) receptor agonist or a sodium-glucose cotransporter-2 (SGLT2) inhibitor had a lower risk of a subsequent stroke, heart attack, or death during a 3-year follow-up period.¹

GLP-1 medications | Image credit: © TensorSpark | stock.adobe.com

According to Johns Hopkins Medicine, experiencing 1 stroke makes it highly likely that patients will experience another. Of the roughly 795,000 individuals in the US who will experience a first stroke in a given year, 23% will suffer a second stroke. Mitigating comorbid conditions such as diabetes, cardiovascular disease, and hypertension can help minimize the risk of secondary stroke.²

“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, since many of the risk factors of a stroke are also associated with other forms of heart disease,” M. Ali Sheffeh, MD, an internal medicine physician and research scholar at the Mayo Clinic, said in a news release. “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.”¹

GLP-1 receptor agonists and SGLT2 inhibitors are commonly prescribed for type 2 diabetes, but they have also shown immense promise in mitigating cardiovascular events. GLP-1 receptor agonists treat diabetes by stimulating insulin release in the pancreas, delaying gastric emptying, and decreasing the release of glucagon. Liraglutide (Victoza; Novo Nordisk), semaglutide (Wegovy; Novo Nordisk), and tirzepatide (Mounjaro; Lilly) are FDA-approved for weight loss and to reduce the risk of cardiovascular disease in individuals with obesity or overweight.¹

SGLT2 inhibitors lower blood sugar levels by inducing the kidneys to remove excess glucose via urine. In this medication class, canagliflozin (Invokana; Johnson & Johnson), dapagliflozin (Farxiga; AstraZeneca), empagliflozin (Jardiance; Lilly), and ertugliflozin (Steglatro; Merck) are FDA-approved for the treatment of type 2 diabetes.¹

In the study presented at AHA 2024, investigators evaluated whether these 2 classes of medications are associated with a decreased risk of heart attacks, secondary stroke, or death in stroke survivors. The study reviewed medical records for more than 7000 adults who had ischemic strokes between January 2000 and June 2022. All participants had received stroke care at hospitals within multiple health systems in Minnesota or Wisconsin.¹

The investigators assessed outcomes for individuals who were prescribed either a GLP-1 or an SGLT2 medication after their initial stroke. Participants were an average of 72 years old, 52% male and 48% female. Furthermore, 94% self-identified as white, 1.5% identified as Black adults, 1.5% identified as Asian adults, and 3% identified as another race.¹

After an average follow-up of 3 years, the analysis found that adults taking one of these medications had a 74% lower risk of death and an 84% lower risk of heart attack. Additionally, adults who were receiving an SGLT2 medication had a 67% lower risk of experiencing another stroke.¹

Throughout the entire study period, the death rate among stroke survivors who took either a GLP-1 or SGLT2 medication was 11.8%, compared with 54% of patients who did not take one of those medications. The rate of heart attacks among the treatment population was 1.5%, compared with 6.1% among those not taking either medication. The rate of having another stroke was similar between patients who did and did not receive either medication, at approximately 6%.¹

All of the decreased risks were present even when researchers accounted for other factors that may have affected risk levels, including age, sex, smoking status, hypertension status, type 2 diabetes status, peripheral artery disease, hyperlipidemia, chronic kidney disease, and a history of heart attack or heart failure.¹

“When comparing multiple variables, we can still conclude that treatment with either medication was associated with lower risk of recurrent stroke even though the rate was similar between patients who did and did not receive either medication,” Sheffeh said in the news release.¹

Additionally, the researchers conducted a subanalysis of patients who took the medications for at least 6 months to confirm whether the medications’ association with a lower risk of heart attack, recurrent stroke, and death could be attributed to the medications. The results were similar to those in the primary study, emphasizing that the treatments were associated with lower risk of heart attack, recurrent stroke, and death.¹

“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,” Cheryl Bushnell, MD, MHS, FAHA, professor and vice chair of research in the department of neurology at Wake Forest University School of Medicine, said in the news release. “These new findings are in line with what we would expect, and we have seen that these outcomes are evident in patients with type 2 diabetes and obesity and in patients with obesity without type 2 diabetes.”¹

The 2024 AHA and American Stroke Association stroke prevention guidelines recommend GLP-1 receptor agonists to reduce the risk of stroke in individuals with diabetes and high cardiovascular risk. Importantly, lifestyle changes such as healthy nutrition, physical activity, and sleep can also help reduce stroke risk.³

REFERENCES

1. GLP-1, SGLT2 medications may lower stroke survivor’s risk of future heart attack, stroke. News release. American Heart Association. November 11, 2024. Accessed November 14, 2024. https://newsroom.heart.org/news/glp-1-sglt2-medications-may-lower-stroke-survivors-risk-of-future-heart-attack-stroke?preview=070d&preview_mode=True

2. 3 Ways to Avoid a Second Stroke. Johns Hopkins Medicine. Accessed November 14, 2024. https://www.hopkinsmedicine.org/health/conditions-and-diseases/stroke/3-ways-to-avoid-a-second-stroke#:~:text=Even%20after%20surviving%20a%20stroke,will%20suffer%20a%20second%20stroke.

3. New guideline: Preventing a first stroke may be possible with screening, lifestyle changes. American Heart Association. October 21, 2024. Accessed November 14, 2024. https://newsroom.heart.org/news/new-guideline-preventing-a-first-stroke-may-be-possible-with-screening-lifestyle-changes