Stroke: Stroke risk reduced by nearly 1/3! Simegrutide benefits people with type 2 diabetes

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With the rapid increase in the prevalence of diabetes, the number of complications including stroke (stroke) is expected to increase
.

In 2015, the prevalence of stroke in people with type 2 diabetes was 18.
6%.


Compared with non-diabetic patients, people with diabetes are more likely to develop a stroke at a young age, with a worse prognosis and a higher
risk of recurrence.

Prevention of stroke, including all its subtypes, should be a major concern
in the clinical management of patients with diabetes.

Studies have shown that glucagon-like peptide-1 receptor agonists, including semeglutide, may reduce the risk
of stroke in patients with type 2 diabetes.

The post-mortem analysis, published in the authoritative journal Stroke in the field of cardiovascular disease, evaluated the effects of
subcutaneous and oral smeglutide on stroke and its subtypes (including ischemic and hemorrhagic stroke) in patients with cardiovascular high-risk type 2 diabetes compared with placebo.

The results showed that smeglutide reduced the incidence
of first stroke in patients with high-risk cardiovascular type 2 diabetes compared with placebo.

In addition, treatment with semeglutide reduces the risk of stroke regardless of whether a stroke has occurred at baseline
.

Screenshot source: Stroke

SUSTAIN 6 (trial assessing cardiovascular and other long-term outcomes of semeglutide in patients with type 2 diabetes) and PIONEER 6 (innovative trial of early diabetes therapeutic peptide) were randomized cardiovascular outcomes for subcutaneous and oral smeglutide in patients with type 2 diabetes at high cardiovascular risk
, respectively.

The Cox proportional risk model was used to analyze the timing of the first stroke and the stroke subtype
.

Interaction P-values were used to assess the effect
of previous stroke, previous myocardial infarction or stroke, age, sex, systolic blood pressure, estimated glomerular filtration rate, and prior atrial fibrillation on treatment outcomes.

The risk
of major cardiovascular adverse events is analyzed based on previous stroke.

The results show:

• SUSTAIN 6 and PIONEER 6 included 6480 participants (smeglutide n=3239; placebo n=3241), of whom 106 had stroke and 6374 had no stroke
  during the trial.
  
  The average age of those without stroke was 65.
  4 ± 7.
  3 years, and the majority of them (64.
  5%) were male
  .
  

  
  

• The risk of occurrence of any first stroke during the trial was 1.
  0 events/100 patients - observation years [PYO]).
  
  

  
  

• Isoglutide therapy reduced the risk of occurrence of any first stroke in the trial compared with placebo (0.
  8 vs.
  1.
  1 event/100 PYO; hazard ratio, 0.
  68 [95% CI, 0.
  46 to 1.
  00]; P=0.
  048), mainly due to a significantly reduced risk of small-vessel occlusion (0.
  3 vs.
  0.
  7 events/100 PYO; Risk ratio, 0.
  51 [95% CI, 0.
  29 to 0.
  89]; P=0.
  017）
  。

  
  

• Treatment of semeglutide had no difference in efficacy between different stroke subtypes: ischemic stroke (incidence: 0.
  7 vs.
  1.
  0 events/100 PYO; HR，0.
  72，[95% CI，0.
  47~1.
  08]； P=0.
  11) and hemorrhagic stroke (incidence: 0.
  1 vs.
  0.
  1 event/100 PYO; HR，0.
  50，[95% CI，0.
  12~1.
  99]； P=0.
  32）
  。
  

• In those patients who did not have a stroke and had a previous stroke, the risk ratio of any stroke risk in the semeglutide versus placebo group was 0.
  60 (95% CI, 0.
  37 to 0.
  99; 0.
  5 vs.
  0.
  9 events/100 PYO) and 0.
  89 (95% CI, 0.
  47 to 1.
  69; 2.
  7 vs.
  3.
  0 events/100 PYO),
  respectively.
  
  

• With the exception of previous atrial fibrillation (P-interaction = 0.
  025), no significant interaction between the effect of treatment on any stroke risk and the subgroup studied, or between the effect of treatment on the risk of major adverse cardiovascular events and previous stroke (P-interaction >0.
  05).