GLP-1 Reduces Recurrent Ischemic Stroke in Type 2 Diabetes

Adding the glucagon-like peptide 1 receptor agonist (GLP-1 RA) liraglutide to standard therapy reduces the risk for recurrent stroke in patients with type 2 diabetes (T2D) and a minor acute ischemic stroke (AIS) or high-risk transient ischemic attack (TIA), results of a new study suggested.

In addition, the study, which is the first large-scale trial to investigate GLP-1 RAs in patients with ischemic stroke, did not significantly increase the rate of intracranial hemorrhage or mortality.

However, because the study was terminated early, the results warrant “careful interpretation,” and additional research is needed to confirm these potential benefits, said the study’s principal investigator Huili Zhu, associate professor at The First Affiliated Hospital of Jinan University, Guangzhou, China.

Zhu presented the findings on February 7 at the International Stroke Conference (ISC) 2025.

Fewer New Strokes

Compared with individuals without T2D, patients with T2D have a two- to fourfold higher risk for stroke and a two- to threefold higher risk for recurrence, Zhu said.

She cited one study that showed 12.8% of patients with T2D who had experienced an AIS had a recurrence within 90 days — a rate 2.2 times higher than that in those with normal blood glucose levels.

While a number of trials have explored the potential cardiovascular benefits of GLP-1 RAs in patients with T2D, few have focused specifically on secondary stroke prevention in the setting of a minor AIS or high-risk TIA.

The Liraglutide in Acute Minor Ischemic Stroke or High-risk Transient Ischemic Attack Patients with Type 2 Diabetes Mellitus (LAMP) study included 636 participants (mean age, 63.5 years; 36.3% women) with T2D from 27 centers in China. The baseline A1c level was 8.2%.

Zhu noted study enrollment was terminated early due to a lower-than-expected recruitment rate (the number of included cases was expected to be 1708).

Participants were randomly assigned to receive either standard therapy alone or standard therapy plus liraglutide. Liraglutide was initiated within an hour of randomization and administered daily via subcutaneous injection for 90 days.

Baseline characteristics were comparable between the two groups, including blood glucose levels and the use of secondary preventive medications.

The study’s primary endpoint was the proportion of new strokes within 90 days. Results revealed 25 new strokes in the liraglutide group and 44 in the control group (hazard ratio, 0.56; 95% CI, 0.34-0.91; P = .02).

At 90 days, compared with 77.8% of patients in the control group, 87.3% of those in the liraglutide group achieved a modified Rankin Scale score ≤ 1 (odds ratio, 1.95; 95% CI, 1.28-3.00; P = .002), a key secondary outcome.

With respect to safety, the rate of symptomatic intracranial hemorrhage was 0.3% in the liraglutide group and 0.6% in the control group, while mortality rates were 0.3% and 1.3%, respectively, with no significant differences between the two groups.

Zhu noted the effects of liraglutide were more pronounced in smokers and men, indicating these factors may influence the efficacy of liraglutide. However, she cautioned that because the sample size didn’t reach the original target, statistical power for detecting interactions in subgroup analyses may be reduced.

A Standout Study

Commenting for Medscape Medical News, Bijoy K. Menon, MD, head of neurology and professor of neurology, radiology and community health sciences, Cumming School of Medicine, University of Calgary in Calgary, Alberta, Canada, and American Stroke Association ISC vice chair, agreed the study is unique and encouraging.

“LAMP adds to a growing body of evidence that GLP-1 RAs may not only help with glycemic control and cardiovascular protection but may also provide stroke-specific benefits in patients with T2D,” said Menon.

“The direct focus on stroke recurrence, coupled with a relatively large multicenter design, makes LAMP stand out,” he added.

The findings suggest a promising strategy for enhancing outcomes in high-risk patients and provide important evidence for clinicians evaluating GLP-1 RA treatment in patients with stroke and T2D, said Menon.

However, the results may not be generalizable to non-Chinese or more ethnically diverse populations, said Menon. “T2D pathophysiology and stroke risk factors can vary by ethnicity and region,” he noted.

“In addition, because the study was terminated early, the results should be interpreted with caution. We don’t have the full scope of data that would have come from the planned sample size, which can lead to inflated effect estimates.”

Another limitation of the study was its open-label design, despite the use of blinded endpoint assessments. “This introduces the potential for performance bias in patient care or adherence,” Menon noted.

LAMP tracked patients for 90 days, which is appropriate for the acute phase, but Menon emphasized that longer follow-up would be valuable to assess sustained risk reduction and long-term functional outcomes.

The study was supported by the Science and Technology Program of Guangzhou. Zhu and Menon reported no relevant conflicts of interest.