GLP-1 Receptor Agonists for Secondary Prevention After Myocardial Infarction and Stroke in Type 2 Diabetes: Nationwide Real-World Evidence

Sedova P, Vrablík M, Kala P, Ošťádal P, Tichopád A, Tomek A, Mikulik R, Donin G, Littnerová S, Kent JA, Jarkovsky J, Somers VK, Brown RD Jr.

Eur J Prev Cardiol. 2026 Jan 7:zwag002. doi: 10.1093/eurjpc/zwag002. Epub ahead of print. PMID: 41499432.

22 Jan 2026

No description

Aims: Glucagon-like peptide-1 receptor agonists (GLP-1RA) reduce cardiovascular risk in patients with type 2 diabetes (T2D) and established atherosclerotic cardiovascular disease and are recommended in guidelines. We evaluated the real-world effectiveness of GLP-1RA therapy on cardiovascular outcomes in patients with T2D after myocardial infarction (MI) or ischemic stroke and examined trends and disparities.

Methods: Using nationwide Czech registry data (2015-2024), we identified patients with incident nonfatal MI or ischemic stroke and confirmed T2D. GLP-1RA users-initiating therapy within 12 months post-event-were propensity score-matched to non-users. The primary outcome was major adverse cardiovascular events (MACE: nonfatal MI, nonfatal stroke, cardiovascular death); secondary outcomes included individual components and all-cause mortality.

Results: GLP-1RA therapy was initiated in only ∼2% of MI and stroke survivors with T2D. Among 126,845 MI survivors, 28,206 had T2D; the matched cohort comprised 2,271 patients (401 GLP-1RA; median follow-up 35 months). GLP-1RA use was associated with lower risk of MACE (HR:0.7; 95%CI:0.52-0.93), all-cause (HR:0.61;95%CI:0.47-0.80) and cardiovascular death (HR:0.54, 95%CI:0.36-0.80). Among 177,115 stroke survivors, 73,750 had T2D; the matched cohort comprised 2,235 patients (385 GLP-1RA; median follow-up 27 months). GLP-1RA use was associated with lower risk of MACE (HR:0.71; 95%CI:0.54-0.94), all-cause (HR:0.59;95%CI:0.46-0.76) and cardiovascular death (HR:0.55; 95%CI:0.37-0.81).

Conclusions: GLP-1RA therapy after MI or stroke in T2D was associated with substantially lower risks of MACE, cardiovascular and all-cause death in real-world practice. Utilization remained low, particularly among women and older adults, underscoring the need for broader and more equitable implementation in secondary prevention.

Keywords: Glucagon-like peptide-1 receptor agonists (GLP-1 RA); health disparities; major adverse cardiovascular events (MACE); myocardial infarction; stroke; type 2 diabetes.


More articles

All articles

You are running an old browser version. We recommend updating your browser to its latest version.

More info