Cerebrovascular Section Best Clinical Scientific Paper Abstract Award - Impact of GLP-1 Receptor Agonist Therapy on Post-Stroke Outcomes in Obese Patients: A Nationwide Propensity Score-Matched Analysis

Introduction: Stroke is a major cause of disability and mortality globally, and obesity is a significant risk factor. Secondary prevention is vital for reducing the risk of recurrent strokes and improving outcomes. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are promising for glycemic control and cardiovascular risk reduction. Earlier studies have shown a reduction in major adverse cardiovascular events but were not powered to evaluate their specific impact on stroke outcomes. Thus, we aimed to investigate the impact of initiating GLP-1RA after stroke on stroke-related outcomes.

Methods: We conducted a retrospective cohort study using TriNetX Research Network data from 2005 to 2023. Patients with obesity (BMI ≥30) and ischemic stroke (ICD-10:I63) with mild stroke severity (NIHSS 2-8) were included. Two cohorts were created: one with patients who started GLP-1RA within a month post-stroke and another with non-users. Outcomes were assessed at 1 month to 1 year post-stroke. Propensity score matching was used.

Results: The study included 191 GLP-1RA users and 17,836 non-users, with 188 patients remaining in each group after matching. Baseline variables were well balanced after matching, with a mean age of 60.1 years and 46.8% females, with 98.1% of patients having diabetes mellitus and 97.9% having hypertension. The median follow-up was 365 days. There was no significant difference in recurrent stroke and/or TIA risk between the groups. All-cause mortality was 0.5-5.3% in the GLP-1RA and 7.4% in the no GLP-1RA group. However, the GLP-1RA group had lower rates of readmission (RR:0.616, 95%CI:0.451-0.842, p=0.002), ED visits (RR:0.681, 95%CI:0.530-0.876, p=0.002), and need for CT/MRI without contrast (RR:0.576, 95%CI:0.398-0.835, p=0.003) were significantly less frequent in the GLP-1RA group.

Conclusion : Initiating GLP-1RA post-stroke in obese patients may reduce ED visits, imaging needs, and readmissions, but does not reduce the risk of recurrent stroke or TIA. Further studies are needed to confirm these findings and understand the underlying mechanisms.