Effects of Glucagon-Like Peptide-1 Receptor Agonist Use After Transient Ischemic Attack on Risks of Subsequent Ischemic Stroke and Mortality.

BACKGROUND AND PURPOSE: A transient ischemic attack (TIA) is associated with a markedly higher risk of subsequent ischemic stroke even when guideline-directed prevention strategies are applied. There is evidence emerging from the LAMP trial that glucagon-like peptide-1 receptor agonists (GLP-1RAs) can help to prevent secondary stroke. We therefore conducted this study to evaluate the association in a real-world cohort.

METHODS

We conducted a retrospective cohort study using data from the TriNetX US Collaborative Network. Adults with TIA who received antithrombotic therapy between 7 days before and 7 days after a TIA diagnosis were included. GLP-1RA use was defined as its initiation between 3 months before to 7 days after a TIA diagnosis. Propensity-score matching (PSM) was performed at a 1:1 ratio to balance covariates. The primary outcomes were ischemic stroke and mortality, while the secondary outcomes were inpatient (IP) admissions and emergency department (ED) visits. Outcomes were assessed over a 5-year follow-up period. Sensitivity analyses stratified by body mass index, hemoglobin-A1c level, and atrial fibrillation status were conducted to generalize the findings.

RESULTS

After applying PSM, 5,071 GLP-1RA users and 5,071 GLP-1RA nonusers were included. GLP-1RA use was associated with lower risks of ischemic stroke (6.9% vs. 10.9%, hazard ratio [HR]=0.76, p<0.001) and mortality (5.9% vs. 12.3%, HR=0.67, p<0.001), as well as fewer IP admissions and ED visits. The results of six sensitivity analyses were consistent with the primary cohort demonstrating the favorable outcomes not being confined to a specific metabolic or vascular risk phenotype.

CONCLUSIONS

GLP-1RA is associated with lower risks of ischemic stroke, mortality, IP admissions, and ED visits in TIA patients. These preliminary findings suggest that GLP-1RAs can play a role in the secondary prevention of cerebrovascular disease.