loss drugs: Do they protect heart, vascular health?
According to the World Stroke Association , one in four adults over the age of 25 will have a stroke during their lifetime, and there are about 12.2 million new strokes diagnosed each year.
Previous research shows that one in four stroke survivors will experience another stroke, and people who have a stroke are at a higher risk of developing major heart issues during the first month after their stroke, such as heart attack — clinically known as myocardial infarction.
Past studies show that stroke survivors can possibly decrease their secondary stroke and heart attack risk through lifestyle changes — such as moving more, eating a healthy diet, and not smoking — and medications .
Now a new study recently presented at the American Heart Association's Scientific Sessions 2024 says that glucagon-like peptide-1 receptor agonists (GLP-1 agonists) — which include medications like Ozempic and Wegovy — and sodium glucose cotransporter 2 (SGLT2) inhibitors may help lower a stroke survivor's risk of experiencing a subsequent stroke, heart attack, or death, compared to those who did not take these medications.
For this study, researchers analyzed medical data for more than 7,000 adults who had an ischemic stroke — the most common type of stroke caused by a blood clot in the artery that brings blood to the brain — between January 2000 and June 2022.
Researchers looked at whether or not study participants had been prescribed either a GLP-1 agonist or SGLT2 inhibitor medication after their initial stroke.
"GLP-1 receptor agonists and SGLT2 inhibitors are two types of medications often used to help people with diabetes manage their blood sugar ," M. Ali Sheffeh, MD , an internal medicine resident at the Henry Ford Medical Center in Warren, MI, research scholar in the Cardiovascular Department at the Mayo Clinic in Rochester, MN, and lead author of this study explained to Medical News Today.
"They also have benefits for heart and kidney health , which has led to their use in patients with certain heart conditions or those at risk of cardiovascular disease," Sheffeh continued.
"These drug classes have been studied over the last few years in randomized clinical trials and have shown better cardiovascular outcomes in patients with obesity , diabetes, heart failure , and chronic kidney disease ," he added.
After an average follow-up of three years, Sheffeh and his team found that stroke survivor participants taking either a GLP-1 or SGLT2 medication had a 74% lower mortality risk and 84% lower risk of having a heart attack, compared to those not taking these drugs.
And participants taking either medication also had a decreased risk of experiencing a secondary stroke, compared to those not taking them.
"The current guideline for stroke prevention recommends the use of blood thinners , controlling blood pressure, and cholesterol lowering medication in addition to lifestyle modification in order to decrease the risk of a second stroke," said Sheffeh.
"If our findings are externally validated, that might lead to changing practice and we might start prescribing these medications for patients with stroke to prevent future events," he pointed out.
"The preventive role of these drug classes might be through their effects on cardiovascular disease risk factors. It's been shown that these drugs might lower blood pressure , improve cholesterol level , and control blood sugar levels . In addition to that, GLP-1 receptor agonists might decrease platelet aggregation and that will lower the risk for another stroke."
– M. Ali Sheffeh, MD
After reviewing this study, Sandra Narayanan, MD , a board-certified vascular neurologist and neurointerventional surgeon, of the Pacific Neuroscience Institute at Providence Saint John's Health Center in Santa Monica, CA, who was not involved in this research, told MNT that she was surprised at powerful the positive response was for both agents to reduce the likelihood of achieving the composite endpoint — mortality, heart attack, or recurrent ischemic stroke.
"In addition to promoting weight loss, GLP-1 receptor agonists reduce inflammation , systolic blood pressure , circulating lipid levels , and fatty liver disease ," Narayanan explained. "SGLT2 inhibitors' direct effects on the kidneys relate to blood pressure reduction , which has cardioprotective effects, especially in heart failure — increasing the efficiency of heart pumping."
"Two major barriers stroke and myocardial infarction patients struggle with are compliance and education," she continued.
Furthermore, "survey-type research addressing prescribing practices might be informative to assess knowledge among prescribers — internists, family physicians, endocrinologists, and stroke neurologists — before and after dissemination of disease-specific studies," said Narayanan.
MNT also spoke with Mir Ali, MD , a board certified general surgeon, bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA, about this study.
"I thought it was an interesting study showing another benefit of these medications, so it's always good to see medications that are helping," Ali said.
As this study showed a potential benefit of these medications, Ali said it was hard to determine at this point how might GLP-1 and SGLT2 medications be positively impacting the heart.
"It would be interesting to see how this is helping patients — if it is an independent effect of just the medication itself, or is it secondary to weight loss or better for glucose control," he added. "A study designed to kind of tease out these details would be helpful."
