Stroke risk in diabetic patients with concomitant cardiovascular disease the CARDIAB-Stroke study.
BACKGROUND Patients with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD) are at high risk of stroke and transient ischemic attack (TIA), yet many remain undertreated with cardioprotective therapies. We assessed stroke risk, its predictors, and the impact of sodium-glucose cotransporter-2 inhibitors (SGLT2-I) and glucagon-like peptide-1 receptor agonists (GLP-1RA). METHODS The nationwide CARdiovascular and DIABetes (CARDIAB) cohort included patients with T2DM and ASCVD. Stroke predictors and associations between SGLT2-I andGLP-1RA use and outcomes were evaluated. RESULTS A total of 138,397 patients (60% male; median age 72 years) were followed for a median of 5.5 years. Overall, 28,676 patients (20.7%) experienced stroke or TIA. Higher risk was associated with smoking, prior stroke or TIA, chronic kidney disease, older age, male sex, and Arab ethnicity. Follow-up in cardiology or endocrinology clinics and treatment with aspirin, statins, SGLT2-I, and GLP-1RA were protective. Patients treated with both SGLT2-I and GLP-1RA had the lowest event rates (361 per 10,000 patient-years), corresponding to a 22% relative risk reduction (HR 0.78; 95% CI, 0.75-0.81). CONCLUSION Patients with T2DM and ASCVD face a markedly elevated stroke risk. SGLT2-I and GLP-1RA use was associated with significant risk reduction, particularly when combined. Greater uptake of these therapies and comprehensive risk factor management are needed to mitigate stroke burden in this high-risk group.