Abstract Body: INTRODUCTION:
Recurrent stroke accounts for approximately 1/4 of all strokes and is associated with high morbidity and mortality. Glucagon-like peptide-1 receptor agonists (GLP-1), while originally developed to treat diabetes, have demonstrated efficacy in preventing cardiovascular events in overweight or obese (BMI>27) patients without diabetes. It is unknown whether these agents could also be useful for preventing recurrence in non-diabetic overweight or obese stroke patients. To guide potential trial planning, we sought to characterize the prevalence of overweight or obesity without diabetes among stroke patients and assess the recurrence rate in these patients at 3 years.
METHODS:
Using the Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS) database from (2015), we identified adult patients with a diagnosis of acute ischemic stroke (AIS) or transient ischemic attack (TIA) and a BMI >27. Patients were separated into two groups based on whether they had a diagnosis of diabetes (either a prior history or a new diagnosis). Demographic information, premorbid mRS, stroke subtype, vascular risk factors and rate of stroke recurrence at 3 years were analyzed. We calculated Kaplan Meier estimates of 3-year recurrence in stroke patients with BMI>27 with and without diabetes. We used a log-rank test to test if there was a difference in the rate of recurrence between the two groups.
Results:
In 2015, of 3086 patients with an AIS or TIA, 3057 had BMI reported and 1644 (54%) with a BMI>27. 859 (52%) of these patients were female, 370 (23%) were Black, and 754 (46%) of these patients had a prior or new diagnosis of diabetes. Overweight or obese patients without diabetes differed from diabetics in race, baseline stroke severity, baseline disability, frequency of HTN and LVH, CAD, smoking and prior stroke. Unadjusted risk of recurrence in non-diabetic overweight or obese patients was 11% (95% CI: 8%, 15%) at 3 years, which was lower than the rate in diabetic overweight or obese of 20% (95% CI: 16%, 26%) (log-rank test p-value <0.01). Unadjusted survival free of stroke in non-diabetic overweight or obese patients was 71% (95% CI: 66%, 75%) at 3 years, which was higher than in diabetic overweight or obese patients of 59% (95% CI: 53%, 65%).
Conclusion:
Of all ischemic stroke and TIA patients, 29% have a BMI>27 without diabetes; these patients have a 3-year stroke recurrence rate of 11% and survival free of stroke of 71%. Clinical trials targeting this group are needed.