AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
GLP-1 Receptor Agonists and the Risk of Ischemic Stroke and All-Cause Mortality in Patients with Asymptomatic Carotid Artery Stenosis
By Shatnawi Y, Hussein L, Yahyavi A et al.
Background: GLP-1 receptor agonists (GLP-1RAs) reduce major adverse cardiovascular events in patients with Type-2 Diabetes Mellitus (T2DM). However, the effects of using GLP-1RAs in patients with asymptomatic carotid artery stenosis (CAS) remain unclear. Hypothesis Among patients with asymptomatic CAS, use of GLP-1RAs is associated with a lower risk of ischemic stroke and all-cause mortality compared with patients not receiving GLP-1 RAs. Goals/Aims To evaluate the association between GLP-1RA therapy and long-term clinical outcomes in patients with asymptomatic CAS, specifically assessing the risk of ischemic stroke and all-cause mortality. Methods: We queried TriNetX to identify adults with asymptomatic CAS, excluding prior transient ischemic attack or cerebral infarction. New GLP-1RA users comprised the exposed cohort, with index defined by first GLP-1 exposure and no prior TIA or stroke. Propensity score matching was performed using demographics, comorbidities, and other medications. Ischemic stroke and all-cause mortality were assessed at 6 months, 1 year, 3 years, and 5 years using the Cox proportional hazards model. Kaplan-Meier (KM) curves and Log-rank tests were applied for time-to-event analysis. Results After matching, 45,539 patients remained in each group. Over a mean follow-up ranging from 165 to 994 days, GLP-1RA use was associated with a significantly lower risk of stroke at all time points (HR 0.641, 95% CI 0.465-0.884 at 6 months; HR 0.678, 95% CI 0.516-0.892 at 1 year; HR 0.667, 95% CI 0.542-0.821 at 3 years; HR 0.780, 95% CI 0.644-0.944 at 5 years). Mortality risk similarly favored GLP-1RA users (HR 0.336, 95% CI 0.304-0.371 at 6 months; HR 0.426, 95% CI 0.396-0.458 at 1 year; HR 0.593, 95% CI 0.565-0.623 at 3 years; HR 0.657, 95% CI 0.630-0.685 at 5 years). Log-rank testing demonstrated significant differences between groups at all time points for both stroke and all-cause mortality. Kaplan-Meier curves demonstrated consistently higher survival and lower ischemic stroke incidence in the GLP-1RA group (Figure 1, Figure 2). Conclusions: In adults with asymptomatic CAS and no prior TIA or cerebral infarction, GLP-1RA therapy was associated with a marked and durable reduction in all-cause mortality and improved overall survival over up to 5 years of follow-up. Stroke risk was also consistently lower across all time points. These data suggest GLP-1RAs may improve long-term vascular outcomes in asymptomatic carotid disease and warrant further evaluation in prospective studies.