TOPLINE:

Use of GLP-1 receptor agonists (RAs) was associated with a 34% reduced risk for nontraumatic subarachnoid hemorrhage (SAH) and a 37% reduced risk for all-cause mortality compared to use of other agents in patients with intracranial aneurysms (IAs) and type 2 diabetes (T2D), a new study showed.

METHODOLOGY:

• A retrospective cohort study used 2010-2025 data from the global TriNetX database for adults with unruptured IAs and T2D, including more than 2500 who received GLP‑1 RAs and more than 23,000 who received other hypoglycemic agents.
• The primary outcomes were incidence of nontraumatic SAH and all-cause mortality during 5 years of follow-up.
• Overall, 95 demographic and clinical variables were used for propensity score matching, resulting in nearly 2300 patients per cohort (mean follow-up duration, 2.4 years for the GLP-1 group and 2.6 years for the non-GLP-1 group).
• A matched subgroup analysis (n = nearly 2000 per treatment group) excluded patients with prior aneurysm treatment.

TAKEAWAY:

• In the propensity-matched analysis, use of GLP-1s was associated with a significantly lower risk for nontraumatic SAH (hazard ratio [HR], 0.66) and all-cause mortality (HR, 0.63) than nonuse. Results were similar in the subgroup of patients without prior aneurysm treatment (HRs, 0.68 and 0.64, respectively).
• In a broader population with IAs that included individuals with and without T2D (n = about 4000 per treatment group), GLP‑1 use was associated with reduced risk for nontraumatic SAH (HR, 0.62) and all-cause mortality (HR, 0.65) compared to non-GLP-1 use.
• Among patients who developed nontraumatic SAH (n = 765 per treatment group), GLP-1s were linked to reduced risk for all-cause mortality (HR, 0.36), hydrocephalus (HR, 0.49), and cognitive decline (HR, 0.74).
• No significant associations were found between GLP-1 use and outcomes such as incidence of prostate or breast cancer.

IN PRACTICE:

“Our study suggests a potential neuroprotective effect of GLP-1 RAs in reducing nontraumatic SAH risk” in patients with T2D and intracranial aneurysms, the investigators wrote. 

“Prospective, controlled trials are needed to confirm these observations and to define the role of [GLP-1s] in SAH prevention within this high-risk population,” they added.

SOURCE:

The study was led by James Feghali, MD, Johns Hopkins University School of Medicine, Baltimore. It was published online on January 6 in Stroke.

LIMITATIONS:

The study population was limited to patients engaged with healthcare systems, which may have introduced a selection bias towards individuals seeking care. The reliance on administrative codes may have introduced miscoding or misclassification issues, and data capture variability across participating institutions affected completeness and consistency. The TriNetX system was unable to capture events at external hospitals or link to the National Death Index, potentially leading to missed events. Additionally, family history and aneurysm location, size, and shape were not available for analysis.

DISCLOSURES:

The study did not receive any funding. Two investigators reported several financial relationships, which are fully listed in the original article. The other seven investigators reported having no relevant conflicts. 

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.