Glucagon-Like Receptor-1 Agonists and Stroke: a Systematic Review and Meta-Analysis of Cardiovascular Outcome Trials

IF 6.3 2区医学 Q1 CLINICAL NEUROLOGY

International Journal of Stroke Pub Date : 2024-04-27 DOI:10.1177/17474930241253988

Anastasia Adamou, Fotios Barkas, Haralampos J Milionis, George Ntaios

{"title":"Glucagon-Like Receptor-1 Agonists and Stroke: a Systematic Review and Meta-Analysis of Cardiovascular Outcome Trials","authors":"Anastasia Adamou, Fotios Barkas, Haralampos J Milionis, George Ntaios","doi":"10.1177/17474930241253988","DOIUrl":null,"url":null,"abstract":"Background:In stroke survivors, approximately 15% and 60% exhibit concurrent diabetes mellitus and overweight/obesity, respectively, necessitating heightened secondary prevention efforts. Despite Glucagon-like receptor-1 agonists (GLP-1 RAs) demonstrating improved outcomes for those with diabetes mellitus or obesity, their underutilization persists among eligible individuals. This systematic review and meta-analysis investigated the impact of GLP-1 RAs on stroke risk. The findings aim to optimize the implementation of this therapeutic strategy in stroke survivors with diabetes mellitus or obesity.Methods:Following PRISMA guidelines, we systematically reviewed MEDLINE and Scopus until 15/11/2023. Eligible studies included randomized cardiovascular outcome trials (CVOTs) with individuals, with or without type 2 diabetes, randomized to either GLP-1 RA or placebo. The outcomes were total strokes, non-fatal strokes, and fatal strokes. Analyses were conducted using RevMan 5.4.1.Results:Among 1,369 screened studies, 11 were eligible, encompassing 82,140 participants (34.6% women) with a cumulative follow-up of 247,596 person-years. In the GLP-1 RAs group, the stroke rate was significantly lower compared to placebo (RR: 0.85, 95% CI: 0.77-0.93; NNT: 200), showing no heterogeneity or interaction with administration frequency (daily vs. weekly). Additionally, the GLP-1 RAs group exhibited a significantly lower rate of non-fatal strokes compared to placebo (RR: 0.87, 95% CI: 0.79-0.95; NNT: 250), with no heterogeneity or interaction based on administration frequency, route (oral vs subcutaneous), or diabetes presence.Conclusion:In this meta-analysis of 11 CVOTs with 82,140 participants, GLP-1 RAs demonstrated a 16% relative reduction in stroke risk compared to placebo. This finding may increase implementation of GLP-1 RAs by stroke specialists in individuals with stroke and comorbid diabetes mellitus or obesity.","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":null,"pages":null},"PeriodicalIF":6.3000,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Stroke","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/17474930241253988","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background:In stroke survivors, approximately 15% and 60% exhibit concurrent diabetes mellitus and overweight/obesity, respectively, necessitating heightened secondary prevention efforts. Despite Glucagon-like receptor-1 agonists (GLP-1 RAs) demonstrating improved outcomes for those with diabetes mellitus or obesity, their underutilization persists among eligible individuals. This systematic review and meta-analysis investigated the impact of GLP-1 RAs on stroke risk. The findings aim to optimize the implementation of this therapeutic strategy in stroke survivors with diabetes mellitus or obesity.Methods:Following PRISMA guidelines, we systematically reviewed MEDLINE and Scopus until 15/11/2023. Eligible studies included randomized cardiovascular outcome trials (CVOTs) with individuals, with or without type 2 diabetes, randomized to either GLP-1 RA or placebo. The outcomes were total strokes, non-fatal strokes, and fatal strokes. Analyses were conducted using RevMan 5.4.1.Results:Among 1,369 screened studies, 11 were eligible, encompassing 82,140 participants (34.6% women) with a cumulative follow-up of 247,596 person-years. In the GLP-1 RAs group, the stroke rate was significantly lower compared to placebo (RR: 0.85, 95% CI: 0.77-0.93; NNT: 200), showing no heterogeneity or interaction with administration frequency (daily vs. weekly). Additionally, the GLP-1 RAs group exhibited a significantly lower rate of non-fatal strokes compared to placebo (RR: 0.87, 95% CI: 0.79-0.95; NNT: 250), with no heterogeneity or interaction based on administration frequency, route (oral vs subcutaneous), or diabetes presence.Conclusion:In this meta-analysis of 11 CVOTs with 82,140 participants, GLP-1 RAs demonstrated a 16% relative reduction in stroke risk compared to placebo. This finding may increase implementation of GLP-1 RAs by stroke specialists in individuals with stroke and comorbid diabetes mellitus or obesity.

查看原文本刊更多论文

胰高血糖素样受体-1 激动剂与中风：心血管结果试验的系统回顾和元分析

背景：在中风幸存者中，分别约有 15% 和 60% 同时患有糖尿病和超重/肥胖症，因此有必要加强二级预防工作。尽管胰高血糖素样受体-1激动剂（GLP-1 RAs）可改善糖尿病或肥胖患者的预后，但在符合条件的患者中仍存在使用不足的情况。本系统综述和荟萃分析调查了 GLP-1 RAs 对中风风险的影响。方法：根据 PRISMA 指南，我们系统回顾了截至 2023 年 11 月 15 日的 MEDLINE 和 Scopus。符合条件的研究包括随机心血管结局试验（CVOTs），研究对象为2型糖尿病患者或非2型糖尿病患者，随机接受GLP-1 RA或安慰剂治疗。研究结果包括脑卒中总数、非致命性脑卒中和致命性脑卒中。结果：在筛选出的 1369 项研究中，有 11 项符合条件，涉及 82140 名参与者（34.6% 为女性），累计随访时间为 247596 人年。与安慰剂相比，GLP-1 RAs 组的中风发生率明显降低（RR：0.85，95% CI：0.77-0.93；NNT：200），且与给药频率（每日给药与每周给药）无异质性或相互作用。此外，与安慰剂相比，GLP-1 RAs 组的非致死性中风发生率明显降低（RR：0.87，95% CI：0.79-0.95；NNT：250），给药频率、给药途径（口服与皮下注射）或是否患有糖尿病均无异质性或相互作用。这一发现可能会增加中风专科医生对中风合并糖尿病或肥胖症患者使用 GLP-1 RAs 的机会。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

International Journal of Stroke 医学-外周血管病

CiteScore

13.90

自引率

6.00%

发文量

132

审稿时长

6-12 weeks

期刊介绍： The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.

文献相关原料

公司名称	产品信息	采购帮参考价格