Use and Eligibility for Glucose-Like Peptide-1 Receptor Agonist Treatment for Primary Prevention of Stroke.

Abstract

The 2024 American Heart Association and American Stroke Association stroke prevention guideline newly recommended glucose-like peptide-1 receptor agonists (GLP-1s) for primary prevention of stroke in patients with diabetes and elevated risk of atherosclerotic cardiovascular disease (ASCVD). We aimed to characterize the population newly recommended GLP-1s. This cross-sectional study included adults aged 30-79 years without previous stroke and with diabetes who participated in the National Health and Nutrition Examination Survey from 2017 to March 2020. Participants were guideline-eligible for GLP-1 if they had HbA1C ≥7% and existing or a high 10-year risk of ASCVD. Current GLP-1 users were identified by in-home review of medications. Data were weighted to be nationally representative. The study included 1,104 participants (mean age 60 years; 45% female) representing 23.5 million (95% CI, 21.2 million-25.8 million) US adults with diabetes. Stroke prevention guideline recommendations would apply to 4.9 million (95% CI, 3.7 million-6.0 million) US adults. GLP-1 eligibility was more common among older adults, men, and those with private insurance or Medicare. Only 6.8% (95% CI 3.3%-10.7%) of adults meeting recommendations were taking a GLP-1. Almost 5 million Americans with diabetes would qualify for GLP-1 use for primary prevention of stroke, but current use among this population is very low.