Risks of stroke, its subtypes and atrial fibrillation associated with glucagon-like peptide 1 receptor agonists versus sodium-glucose cotransporter 2 inhibitors: a real-world population-based cohort study in Hong Kong
Main finding · All strokeResult — go to the resultHazard ratio 1.46 95% CI 0.99–2.17Authors' conclusion
Our real-world study demonstrated that GLP-1RA use was associated with lower risk of ischemic stroke, despite the association between SGLT2i use and lower risk of incident AF. There was no significant difference in hemorrhagic stroke risk. GLP-1RA may be the preferred agent for patients with type 2 diabetes at risk of ischemic stroke.
Study context
- Population
- Patients with T2D, 2008–2020, Hong Kong Hospital Authority electronic health records; mean age 55.5 years, 56.1% men, mean HbA1c 8.9%, diabetes duration 13.7 yearsmatched cohort
- Participants
- 5,840 patients
- Exposure
- SGLT2i vs GLP-1 RA
- SGLT2in = 2,920
- GLP-1RAn = 2,920reference
- Outcome
- Stroke (all stroke)
- Follow-up
- Median 17 months
Methodological detailspopulation-based, propensity-score matched
- Population-based
- Propensity-score matched
Main finding
All stroke
Hazard ratio
1.46
95% CI 0.99–2.17
P = 0.058
Events by group
SGLT2ivs GLP-1RA
HR 1.46 (95% CI 0.99–2.17); P = 0.058
As reported in the abstract
- Total stroke events
- 111 (1.9%)
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Ischemic strokeHigher risk with SGLT2i | 1.53 (1.01–2.33) | P = 0.044 | |
| Incident AFLower risk with SGLT2i | 0.43 (0.23–0.79) | P = 0.006 | |
| 0.20.5125Hazard ratio (log scale) |
Hemorrhagic stroke
- Similar risk of hemorrhagic stroke, SGLT2i vs GLP-1RA
Cardioembolic stroke
- Risk of cardioembolic stroke was similar
Original publication
Risks of stroke, its subtypes and atrial fibrillation associated with glucagon-like peptide 1 receptor agonists versus sodium-glucose cotransporter 2 inhibitors: a real-world population-based cohort study in Hong Kong. Cardiovasc Diabetol. Published 24 February 2023. doi:10.
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