Cardiometabolic drugs after stroke: time to embrace SGLT2 inhibitors and incretin-based therapies?

Stroke is a multifactorial cardiovascular disease (CVD), which predominantly affects older adults. Consequently, cardiovascular risk factors and related comorbidities are highly prevalent among people presenting with acute stroke. These conditions, and the stroke event itself, may require specific pharmacological therapies to reduce subsequent risk. Over recent decades, two novel pharmacological drug classes, sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists, which were initially developed as glucose-lowering therapies for type 2 diabetes mellitus, have been used for management of related cardiovascular conditions. These agents are not currently included in secondary stroke prevention guidelines, despite growing evidence suggesting that they may directly or indirectly improve long-term, stroke-related outcomes. It is therefore essential that the stroke community remains up-to-date with these developments while awaiting updated clinical guidelines. This will ensure optimal management of coexisting cardiovascular disease and reduce subsequent risk. In this commentary, we summarize and discuss what we consider to be the most relevant and impactful recent studies for contemporary clinical stroke practice.