Sodium-glucose cotransporter 2 inhibitors and stroke risk in patients with diabetes and stroke risk factors: A real-world cohort study.

IF 8.7 2区医学 Q1 CLINICAL NEUROLOGY

International Journal of Stroke Pub Date : 2025-07-23 DOI:10.1177/17474930251364060

Bing-Hua Lin, Hui-Min Huang, Hui-An Lin, Sheng-Feng Lin

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引用次数: 0

Abstract

Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve the cardiovascular outcomes of patients with type 2 diabetes (T2D). However, whether this effect extends to stroke prevention in high-risk patients remains unclear.

Aims: This study aims to investigate the effect of SGLT2i in stroke prevention in patients with T2D and concomitant risk factors.

Methods: Patients with T2D and various risk factors for stroke were identified from the TriNetX platform from 2013 to 2024. These patients were divided into two cohorts: one treated with SGLT2i, and the other with metformin or dipeptidyl peptidase-4 inhibitors. Propensity score matching was used to balance the patients' demographic characteristics, underlying comorbidities, and antiplatelet and anticoagulant drug use patterns. The primary outcome was the development of ischemic or hemorrhagic stroke or the onset of a transient ischemic attack (TIA) within 1 year. Unadjusted Cox proportional hazards models were applied to estimate hazard ratios (HRs). Sensitivity analyses stratified by age, sex, and hemoglobin A1c (HbA1c) levels were performed, and interaction tests were used to assess potential effect modifiers. In addition, the two cohorts were compared for estimation of numbers needed to treat (NNTs).

Results: A total of 3,715,058 patients were identified, of whom 971,727 (26.2%) were SGLT2i users. After matching, 932,419 patients were included in each group. SGLT2i use was associated with a significantly reduced risk of ischemic stroke (HR: 0.84, 95% confidence interval (CI): 0.81-0.87; NNT: 669), hemorrhagic stroke (HR: 0.73, 95% CI: 0.68-0.79; NNT: 1837), and TIA (HR: 0.81, 95% CI: 0.77-0.86; NNT: 1615). The protective effect against ischemic stroke was more pronounced in males and individuals aged over 65 years. Greater benefit was observed in patients with chronic kidney disease (NNT: 466), atrial fibrillation (NNT: 492), and heart failure (NNT: 415). In contrast, the protective effect was attenuated in patients with obesity, among whom SGLT2i use was associated with a modestly increased risk of ischemic stroke after 1 year (HR: 1.05, 95% CI: 1.01-1.09).

Conclusion: SGLT2i use is associated with a significant reduction in the risk of stroke among selected T2D patients. SGLT2i may be used as a first-line therapy for diabetes patients with concomitant chronic kidney disease, atrial fibrillation, and heart failure.

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钠-葡萄糖共转运蛋白2抑制剂与糖尿病患者卒中风险及卒中危险因素：一项真实世界队列研究

背景：钠-葡萄糖共转运蛋白2抑制剂（SGLT2i）可改善2型糖尿病（T2D）患者的心血管结局。然而，这种效果是否延伸到高危患者的中风预防仍不清楚。目的：本研究旨在探讨SGLT2i在T2D患者脑卒中预防中的作用及相关危险因素。方法：2013年至2024年在TriNetX平台上识别t2dm及卒中各种危险因素的患者。这些患者被分为两组：一组接受SGLT2i治疗，另一组接受二甲双胍或二肽基肽酶-4抑制剂治疗。倾向评分匹配用于平衡患者的人口统计学特征、潜在合并症以及抗血小板和抗凝药物使用模式。主要结局是1年内缺血性或出血性卒中的发展或短暂性脑缺血发作（TIA）的发作。采用未调整的Cox比例风险模型估计风险比（hr）。进行了按年龄、性别和HbA1c水平分层的敏感性分析，并使用相互作用试验来评估潜在的效果调节剂。此外，对两个队列进行比较，估计需要治疗的人数（nnt）。结果：共发现3715058例患者，其中971727例（26.2%）为SGLT2i使用者。匹配后，每组共纳入932419例患者。SGLT2i的使用与缺血性卒中风险显著降低相关(HR:0.84, 95% CI:0.81-0.87；NNT:669)，出血性卒中(HR:0.73, 95% CI:0.68-0.79；NNT:1837)和TIA (HR:0.81, 95% CI:0.77-0.86；例数十分:1615)。对缺血性中风的保护作用在男性和65岁以上的个体中更为明显。在慢性肾病（NNT:466）、房颤（NNT:492）和心力衰竭（NNT:415）患者中观察到更大的获益。相比之下，肥胖患者的保护作用减弱，其中SGLT2i的使用与一年后缺血性卒中风险适度增加相关（HR:1.05, 95% CI:1.01-1.09）。结论：在选定的T2D患者中，SGLT2i的使用与卒中风险的显著降低相关。SGLT2i可作为糖尿病合并慢性肾病、心房颤动和心力衰竭患者的一线治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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.