GLP-1 Receptor Agonists for Secondary Prevention After MI and Stroke in T2D
Overview
Real-world evidence from a nationwide Czech registry indicates that initiation of GLP-1 receptor agonists (GLP-1RAs) after myocardial infarction (MI) or ischemic stroke in patients with type 2 diabetes (T2D) is associated with approximately 30% lower risk of major adverse cardiovascular events (MACEs) and 40–45% lower cardiovascular and all-cause mortality. Despite these benefits, GLP-1RA uptake remains very low, especially among older adults and women post-stroke.
Background
Patients with T2D who survive MI or ischemic stroke are at very high risk for recurrent cardiovascular events and premature death due to advanced atherosclerosis and metabolic complications. Although large cardiovascular outcome trials have demonstrated cardiovascular benefits of GLP-1RAs beyond glycemic control, these patients have been under-represented in such trials. Real-world data are crucial to understand the effectiveness and implementation of GLP-1RAs in routine clinical practice for secondary prevention in this population.
Data Highlights
Parameter
Value
Number of MI or stroke survivors identified (2015-2024)
>300,000
Patients with confirmed T2D
>100,000
GLP-1RA initiation within 12 months post-MI
<2%
GLP-1RA initiation within 12 months post-stroke
~0.5%
Risk reduction in MACE with GLP-1RA
~30%
Risk reduction in cardiovascular and all-cause mortality
40–45%
Key Findings
GLP-1RA use after MI or ischemic stroke in T2D patients is associated with significant reductions in MACE and mortality.
Despite high baseline risk, GLP-1RA uptake within 12 months post-event is very low (<2% post-MI, ~0.5% post-stroke).
Older adults and women, particularly after stroke, are less likely to receive GLP-1RA therapy.
Observed mortality hazard ratios (~0.55) exceed those reported in randomized trials, suggesting potential overestimation due to unmeasured confounding.
Selective prescribing influenced by factors such as frailty, socioeconomic position, and weight-related indications likely biases results.
Robust observational methods were used to mitigate biases, but residual confounding remains a limitation.
Clinical Implications
GLP-1RAs represent a promising addition to secondary prevention strategies for high-risk T2D patients after MI or ischemic stroke, potentially reducing recurrent cardiovascular events and mortality. However, their underutilization in routine practice highlights the need to address barriers to prescribing, especially among older adults and women. Clinicians should consider patient-specific factors and evolving evidence when integrating GLP-1RAs into post-event care.
Conclusion
This real-world study supports the cardiovascular benefits of GLP-1RAs for secondary prevention in T2D patients after MI or stroke but underscores a substantial treatment gap. Careful interpretation of observational data is warranted due to potential confounding, and efforts to optimize appropriate GLP-1RA use in clinical practice are needed.
