Glucagonlike peptide‐1 receptor agonists versus dipeptidyl peptidase‐4 inhibitors in ischemic strokes with diabetes 2
Background and purpose Cardiovascular outcome trials demonstrate that glucagonlike peptide‐1 receptor agonists (GLP‐1RAs) reduce the risk of major adverse cardiovascular events in patients with type 2 diabetes (T2D), whereas dipeptidyl peptidase‐4 inhibitors (DPP‐4is) have not shown cardiovascular b...
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creator | Hastrup, Sidsel Hedegaard, Jakob Nebeling Andersen, Grethe Rungby, Jørgen Johnsen, Soren Paaske |
description | Background and purpose
Cardiovascular outcome trials demonstrate that glucagonlike peptide‐1 receptor agonists (GLP‐1RAs) reduce the risk of major adverse cardiovascular events in patients with type 2 diabetes (T2D), whereas dipeptidyl peptidase‐4 inhibitors (DPP‐4is) have not shown cardiovascular benefits. We compared acute ischemic stroke (AIS) with T2D treated with either a GLP‐1RA or DPP‐4i prior to the index stroke.
Methods
This national cohort study included AIS patients with T2D from 2017 to 2020 in Denmark who were users of a GLP‐1RA or DPP‐4i. To be categorized as a user, we required at least 12 months of exposure and no concurrent treatment with another newer glucose‐lowering medication during the last 3 months prior to the index stroke. GLP‐1RA users were compared to users of DPP‐4i while adjusting for the calendar year of index stroke, age, sex, comorbidity, and socioeconomic factors.
Results
The study included 1567 AIS events with T2D; 593 were users of GLP‐1RA and 974 of DPP‐4i. The absolute risk of a very severe stroke was 2.4% (95% confidence interval [CI] = 1.2–3.7) in GLP‐1RA users and 6.1% (95% CI = 4.6–7.7) in DPP‐4i users. The corresponding adjusted risk ratio (aRR) of GLP‐1RA versus DPP‐4i was 0.49 (95% CI = 0.24–1.00). The aRRs of 30‐day and 365‐day mortality were 0.55 (95% CI = 0.32–0.94) and 0.72 (95% CI = 0.53–0.98), respectively.
Conclusions
The risk of a very severe stroke as well as the 30‐day and 365‐day poststroke mortality rates were lower among the AIS patients with comorbid T2D receiving GLP‐1RA prior to the index stroke compared to those receiving DPP‐4i. Hence, GLP‐1RA may improve stroke outcomes in comparison with DPP‐4i. |
doi_str_mv | 10.1111/ene.16329 |
format | Article |
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Cardiovascular outcome trials demonstrate that glucagonlike peptide‐1 receptor agonists (GLP‐1RAs) reduce the risk of major adverse cardiovascular events in patients with type 2 diabetes (T2D), whereas dipeptidyl peptidase‐4 inhibitors (DPP‐4is) have not shown cardiovascular benefits. We compared acute ischemic stroke (AIS) with T2D treated with either a GLP‐1RA or DPP‐4i prior to the index stroke.
Methods
This national cohort study included AIS patients with T2D from 2017 to 2020 in Denmark who were users of a GLP‐1RA or DPP‐4i. To be categorized as a user, we required at least 12 months of exposure and no concurrent treatment with another newer glucose‐lowering medication during the last 3 months prior to the index stroke. GLP‐1RA users were compared to users of DPP‐4i while adjusting for the calendar year of index stroke, age, sex, comorbidity, and socioeconomic factors.
Results
The study included 1567 AIS events with T2D; 593 were users of GLP‐1RA and 974 of DPP‐4i. The absolute risk of a very severe stroke was 2.4% (95% confidence interval [CI] = 1.2–3.7) in GLP‐1RA users and 6.1% (95% CI = 4.6–7.7) in DPP‐4i users. The corresponding adjusted risk ratio (aRR) of GLP‐1RA versus DPP‐4i was 0.49 (95% CI = 0.24–1.00). The aRRs of 30‐day and 365‐day mortality were 0.55 (95% CI = 0.32–0.94) and 0.72 (95% CI = 0.53–0.98), respectively.
Conclusions
The risk of a very severe stroke as well as the 30‐day and 365‐day poststroke mortality rates were lower among the AIS patients with comorbid T2D receiving GLP‐1RA prior to the index stroke compared to those receiving DPP‐4i. Hence, GLP‐1RA may improve stroke outcomes in comparison with DPP‐4i.</description><identifier>ISSN: 1351-5101</identifier><identifier>ISSN: 1468-1331</identifier><identifier>EISSN: 1468-1331</identifier><identifier>DOI: 10.1111/ene.16329</identifier><identifier>PMID: 38715389</identifier><language>eng</language><publisher>England: John Wiley & Sons, Inc</publisher><subject>Aged ; Aged, 80 and over ; Agonists ; Cardiovascular diseases ; cerebrovascular disease/stroke ; Clinical trials ; Cohort Studies ; Comorbidity ; Denmark - epidemiology ; Diabetes ; Diabetes mellitus (non-insulin dependent) ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - drug therapy ; Dipeptidyl-Peptidase IV Inhibitors - therapeutic use ; Female ; Glucagon-Like Peptide-1 Receptor - agonists ; Humans ; Hypoglycemic Agents - therapeutic use ; Inhibitors ; Ischemia ; Ischemic Stroke - drug therapy ; Ischemic Stroke - epidemiology ; Male ; Middle Aged ; Mortality ; outcome research ; Peptidases ; Peptides ; Receptors ; Risk ; Socioeconomic factors ; Socioeconomics ; Stroke</subject><ispartof>European journal of neurology, 2024-08, Vol.31 (8), p.e16329-n/a</ispartof><rights>2024 The Authors. published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.</rights><rights>2024 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.</rights><rights>2024. This article is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3489-23663583e2c2a3e26383b3a4bd2fcde97cd73b735fc87e05455e22e8bceba6323</cites><orcidid>0000-0002-5232-8409</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fene.16329$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fene.16329$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>315,782,786,1419,11569,27931,27932,45581,45582,46059,46483</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38715389$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hastrup, Sidsel</creatorcontrib><creatorcontrib>Hedegaard, Jakob Nebeling</creatorcontrib><creatorcontrib>Andersen, Grethe</creatorcontrib><creatorcontrib>Rungby, Jørgen</creatorcontrib><creatorcontrib>Johnsen, Soren Paaske</creatorcontrib><title>Glucagonlike peptide‐1 receptor agonists versus dipeptidyl peptidase‐4 inhibitors in ischemic strokes with diabetes 2</title><title>European journal of neurology</title><addtitle>Eur J Neurol</addtitle><description>Background and purpose
Cardiovascular outcome trials demonstrate that glucagonlike peptide‐1 receptor agonists (GLP‐1RAs) reduce the risk of major adverse cardiovascular events in patients with type 2 diabetes (T2D), whereas dipeptidyl peptidase‐4 inhibitors (DPP‐4is) have not shown cardiovascular benefits. We compared acute ischemic stroke (AIS) with T2D treated with either a GLP‐1RA or DPP‐4i prior to the index stroke.
Methods
This national cohort study included AIS patients with T2D from 2017 to 2020 in Denmark who were users of a GLP‐1RA or DPP‐4i. To be categorized as a user, we required at least 12 months of exposure and no concurrent treatment with another newer glucose‐lowering medication during the last 3 months prior to the index stroke. GLP‐1RA users were compared to users of DPP‐4i while adjusting for the calendar year of index stroke, age, sex, comorbidity, and socioeconomic factors.
Results
The study included 1567 AIS events with T2D; 593 were users of GLP‐1RA and 974 of DPP‐4i. The absolute risk of a very severe stroke was 2.4% (95% confidence interval [CI] = 1.2–3.7) in GLP‐1RA users and 6.1% (95% CI = 4.6–7.7) in DPP‐4i users. The corresponding adjusted risk ratio (aRR) of GLP‐1RA versus DPP‐4i was 0.49 (95% CI = 0.24–1.00). The aRRs of 30‐day and 365‐day mortality were 0.55 (95% CI = 0.32–0.94) and 0.72 (95% CI = 0.53–0.98), respectively.
Conclusions
The risk of a very severe stroke as well as the 30‐day and 365‐day poststroke mortality rates were lower among the AIS patients with comorbid T2D receiving GLP‐1RA prior to the index stroke compared to those receiving DPP‐4i. Hence, GLP‐1RA may improve stroke outcomes in comparison with DPP‐4i.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Agonists</subject><subject>Cardiovascular diseases</subject><subject>cerebrovascular disease/stroke</subject><subject>Clinical trials</subject><subject>Cohort Studies</subject><subject>Comorbidity</subject><subject>Denmark - epidemiology</subject><subject>Diabetes</subject><subject>Diabetes mellitus (non-insulin dependent)</subject><subject>Diabetes Mellitus, Type 2 - complications</subject><subject>Diabetes Mellitus, Type 2 - drug therapy</subject><subject>Dipeptidyl-Peptidase IV Inhibitors - therapeutic use</subject><subject>Female</subject><subject>Glucagon-Like Peptide-1 Receptor - agonists</subject><subject>Humans</subject><subject>Hypoglycemic Agents - therapeutic use</subject><subject>Inhibitors</subject><subject>Ischemia</subject><subject>Ischemic Stroke - drug therapy</subject><subject>Ischemic Stroke - epidemiology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>outcome research</subject><subject>Peptidases</subject><subject>Peptides</subject><subject>Receptors</subject><subject>Risk</subject><subject>Socioeconomic factors</subject><subject>Socioeconomics</subject><subject>Stroke</subject><issn>1351-5101</issn><issn>1468-1331</issn><issn>1468-1331</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><recordid>eNp1kbtOxDAQRS0E4l3wA8gSDRQB2xPnUaLV8pAQNFBHjjPLGrLJYieg7fgEvpEvYZYsFEi4sGfkc69Gcxk7kOJU0jnDBk9lAipfY9syTrJIAsh1qkHLSEsht9hOCE9CCJUqscm2IEulhizfZovLurfmsW1q94x8jvPOVfj5_iG5R0td6_ny14Uu8Ff0oQ-8cgO2qFe8CUtFzF0zdaUjSaCSu2CnOHOWh863zxj4m-umJDYldtSpPbYxMXXA_dW7yx4uxvejq-jm7vJ6dH4TWYizPFKQJKAzQGWVoTuBDEowcVmpia0wT22VQpmCntgsRaFjrVEpzEqLpaGdwC47Hnznvn3pMXTFjEbDujYNtn0oQGilcyVjTejRH_Sp7X1D0xGVJjKWUiREnQyU9W0IHifF3LuZ8YtCimKZR0F5FN95EHu4cuzLGVa_5E8ABJwNwJurcfG_UzG-HQ-WXxAgl2s</recordid><startdate>202408</startdate><enddate>202408</enddate><creator>Hastrup, Sidsel</creator><creator>Hedegaard, Jakob Nebeling</creator><creator>Andersen, Grethe</creator><creator>Rungby, Jørgen</creator><creator>Johnsen, Soren Paaske</creator><general>John Wiley & Sons, Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>7U7</scope><scope>C1K</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5232-8409</orcidid></search><sort><creationdate>202408</creationdate><title>Glucagonlike peptide‐1 receptor agonists versus dipeptidyl peptidase‐4 inhibitors in ischemic strokes with diabetes 2</title><author>Hastrup, Sidsel ; Hedegaard, Jakob Nebeling ; Andersen, Grethe ; Rungby, Jørgen ; Johnsen, Soren Paaske</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3489-23663583e2c2a3e26383b3a4bd2fcde97cd73b735fc87e05455e22e8bceba6323</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Agonists</topic><topic>Cardiovascular diseases</topic><topic>cerebrovascular disease/stroke</topic><topic>Clinical trials</topic><topic>Cohort Studies</topic><topic>Comorbidity</topic><topic>Denmark - epidemiology</topic><topic>Diabetes</topic><topic>Diabetes mellitus (non-insulin dependent)</topic><topic>Diabetes Mellitus, Type 2 - complications</topic><topic>Diabetes Mellitus, Type 2 - drug therapy</topic><topic>Dipeptidyl-Peptidase IV Inhibitors - therapeutic use</topic><topic>Female</topic><topic>Glucagon-Like Peptide-1 Receptor - agonists</topic><topic>Humans</topic><topic>Hypoglycemic Agents - therapeutic use</topic><topic>Inhibitors</topic><topic>Ischemia</topic><topic>Ischemic Stroke - drug therapy</topic><topic>Ischemic Stroke - epidemiology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>outcome research</topic><topic>Peptidases</topic><topic>Peptides</topic><topic>Receptors</topic><topic>Risk</topic><topic>Socioeconomic factors</topic><topic>Socioeconomics</topic><topic>Stroke</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hastrup, Sidsel</creatorcontrib><creatorcontrib>Hedegaard, Jakob Nebeling</creatorcontrib><creatorcontrib>Andersen, Grethe</creatorcontrib><creatorcontrib>Rungby, Jørgen</creatorcontrib><creatorcontrib>Johnsen, Soren Paaske</creatorcontrib><collection>Wiley Online Library (Open Access Collection)</collection><collection>Wiley Free Content</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hastrup, Sidsel</au><au>Hedegaard, Jakob Nebeling</au><au>Andersen, Grethe</au><au>Rungby, Jørgen</au><au>Johnsen, Soren Paaske</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Glucagonlike peptide‐1 receptor agonists versus dipeptidyl peptidase‐4 inhibitors in ischemic strokes with diabetes 2</atitle><jtitle>European journal of neurology</jtitle><addtitle>Eur J Neurol</addtitle><date>2024-08</date><risdate>2024</risdate><volume>31</volume><issue>8</issue><spage>e16329</spage><epage>n/a</epage><pages>e16329-n/a</pages><issn>1351-5101</issn><issn>1468-1331</issn><eissn>1468-1331</eissn><abstract>Background and purpose
Cardiovascular outcome trials demonstrate that glucagonlike peptide‐1 receptor agonists (GLP‐1RAs) reduce the risk of major adverse cardiovascular events in patients with type 2 diabetes (T2D), whereas dipeptidyl peptidase‐4 inhibitors (DPP‐4is) have not shown cardiovascular benefits. We compared acute ischemic stroke (AIS) with T2D treated with either a GLP‐1RA or DPP‐4i prior to the index stroke.
Methods
This national cohort study included AIS patients with T2D from 2017 to 2020 in Denmark who were users of a GLP‐1RA or DPP‐4i. To be categorized as a user, we required at least 12 months of exposure and no concurrent treatment with another newer glucose‐lowering medication during the last 3 months prior to the index stroke. GLP‐1RA users were compared to users of DPP‐4i while adjusting for the calendar year of index stroke, age, sex, comorbidity, and socioeconomic factors.
Results
The study included 1567 AIS events with T2D; 593 were users of GLP‐1RA and 974 of DPP‐4i. The absolute risk of a very severe stroke was 2.4% (95% confidence interval [CI] = 1.2–3.7) in GLP‐1RA users and 6.1% (95% CI = 4.6–7.7) in DPP‐4i users. The corresponding adjusted risk ratio (aRR) of GLP‐1RA versus DPP‐4i was 0.49 (95% CI = 0.24–1.00). The aRRs of 30‐day and 365‐day mortality were 0.55 (95% CI = 0.32–0.94) and 0.72 (95% CI = 0.53–0.98), respectively.
Conclusions
The risk of a very severe stroke as well as the 30‐day and 365‐day poststroke mortality rates were lower among the AIS patients with comorbid T2D receiving GLP‐1RA prior to the index stroke compared to those receiving DPP‐4i. Hence, GLP‐1RA may improve stroke outcomes in comparison with DPP‐4i.</abstract><cop>England</cop><pub>John Wiley & Sons, Inc</pub><pmid>38715389</pmid><doi>10.1111/ene.16329</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-5232-8409</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Aged Aged, 80 and over Agonists Cardiovascular diseases cerebrovascular disease/stroke Clinical trials Cohort Studies Comorbidity Denmark - epidemiology Diabetes Diabetes mellitus (non-insulin dependent) Diabetes Mellitus, Type 2 - complications Diabetes Mellitus, Type 2 - drug therapy Dipeptidyl-Peptidase IV Inhibitors - therapeutic use Female Glucagon-Like Peptide-1 Receptor - agonists Humans Hypoglycemic Agents - therapeutic use Inhibitors Ischemia Ischemic Stroke - drug therapy Ischemic Stroke - epidemiology Male Middle Aged Mortality outcome research Peptidases Peptides Receptors Risk Socioeconomic factors Socioeconomics Stroke |
title | Glucagonlike peptide‐1 receptor agonists versus dipeptidyl peptidase‐4 inhibitors in ischemic strokes with diabetes 2 |
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